medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2025, Number 6

<< Back Next >>

Ginecol Obstet Mex 2025; 93 (6)

Abnormal uterine Doppler as a predictor of preeclampsia in high-risk pregnancies

Molina PCJ, Berumen LMG, Moreno ÁÓ, Borja VM, Amaya HLD

Language: Spanish
References: 30
Page: 191-202
PDF size: 319.62 Kb.


ABSTRACT

Objective: To assess the association between abnormal Doppler flowmetry of the arteries and the occurrence of preeclampsia in Mexican women with high-risk pregnancies during the second trimester.
Materials and Methods: A prospective cohort study was conducted on patients with comorbidities between 20 and 24 weeks of pregnancy. A percentile ≥ 95 was considered abnormal when measuring the mean pulsatility index. We calculated the incidence of preeclampsia and considered the following parameters: admission to the intensive care unit and perinatal outcomes between groups (normal versus abnormal). Differences in means were calculated using Student's t-test and the Mann-Whitney U-test. The chi-square test was used to compare different proportions, and the odds ratio was used to determine the strength of association.
Results: Eighty-two patients were studied and divided into two groups. A higher frequency of preeclampsia was recorded in the group with abnormal uterine Doppler flow (36% versus 12.2%; p ‹ 0.001; relative risk [RR] 4.1; 95% confidence interval [CI]: 1.3-12.87). There were more maternal complications, including more intensive care admissions for preeclampsia (22% compared to 2.4%; p ‹ 0.001; RM 1.3; 95% CI: 1.3-93.5). Perinatal outcomes showed a higher risk of low birth weight (p ‹ 10; RM 3.5; 95% CI: 1.4-9.1 and p ‹ 3; RM 3.3; 95% CI: 3.3-9.8) and admission to the neonatal intensive care unit (RM 1.2; 95% CI: 1.1-1.5).
Conclusion: Abnormal uterine Doppler flow in the second trimester is significantly associated with preeclampsia, serious maternal complications (e.g., admission to intensive care), and adverse neonatal outcomes (e.g., low birth weight, admission to intensive care) in high-risk obstetric pregnancies.


REFERENCES

  1. Zolness N. High-risk pregnancy. Nurs Clin North Am 2018; 53 (2): 241-51. https://doi.org/10.1016/j.cnur.2018.01.010

  2. Coco L, Giannone TT, Zarbo G. Management of high-risk pregnancy. Minerva Ginecol 2014; 66 (4): 383-9

  3. Okido MM, Bettiol H, Barbieri MA, et al. Can increased resistance to uterine artery flow be a risk factor for adverse neurodevelopmental outcomes in childhood? A prospective cohort study. J Obstet Gynaecol 2020; 40 (6): 784-91. https: //doi.org/10.1080/01443615.2019.1666094

  4. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135 (6): e237-e60. https://doi.org/10.1097/aog.0000000000003891

  5. Carbillon L, Uzan M, Uzan S. Pregnancy, vascular tone, and maternal hemodynamics: a crucial adaptation. Obstet Gynecol Surv 2000; 55 (9): 574-81. https://doi.org/10.1097/00006254-200009000-00023

  6. Eid J, Rood KM, Costantine MM. Aspirin and Pravastatin for Preeclampsia Prevention in High-Risk Pregnancy. Obstet Gynecol Clin North Am 2023; 50 (1): 79-88. https://doi.org/10.1016/j.ogc.2022.10.005

  7. Phipps EA, Thadhani R, Benzing T, et al. Pre-eclampsia pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol 2019; 15 (5): 275-89. https://doi.org/10.1038/s41581-019-0119-6

  8. Moloney A, Hladunewich M, Manly E, et al. The predictive value of sonographic placental markers for adverse pregnancy outcome in women with chronic kidney disease. Pregnancy Hypertens 2020; 20: 27-35. https://doi.org/10.1016/j.preghy.2020.02.004

  9. Lakshmy S, Ziyaulla T, Rose N. The need for implementation of first trimester screening for preeclampsia and fetal growth restriction in low resource settings. J Matern Fetal Neonatal Med 2021; 34 (24):4082-9. https://doi.org/10.1080/14767058.2019.1704246

  10. Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet 2019; 145 (Suppl 1): 1-33. https://doi.org/10.1002/ijgo.12802

  11. Gómez O, Figueras F, Fernández S, et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol 2008; 32 (2): 128-32. https://doi.org/10.1002/uog.5315

  12. Chen JY, Chen M, Wu XJ, et al. The value of placental vascularization indices for predicting preeclampsia and fetal growth restriction in different stages of gestation: A prospective and longitudinal study. Placenta 2022; 122: 1-8. https//doi.org/10.1016/j.placenta.2022.03.124

  13. Bohórquez-Camargo DC, Guerrero-Solano AM, Becerra-Mojica CH, et al. Doppler de arterias uterinas en embarazadas hipertensas crónicas como predictor de preeclampsia con criterios de severidad sobreagregada y necesidad de cuidados intensivos. Ginecol Obstet Mex 2021; 89 (8): 611-21. https://doi.org/https://doi.org/10.24245/gom.v89i8.5473

  14. Leaños-Miranda A, Graciela Nolasco-Leaños A, Ismael Carrillo-Juárez R, et al. Usefulness of the sFlt-1/PlGF (Soluble fms-Like Tyrosine Kinase-1/Placental Growth Factor) Ratio in Diagnosis or Misdiagnosis in Women With Clinical Diagnosis of Preeclampsia. Hypertension 2020; 76 (3): 892-900. https://doi.org/10.1161/hypertensionaha.120.15552

  15. Chen JY, Yu BL, Wu XJ, et al. A longitudinal and cross-sectional study of placental circulation between normal and placental insufficiency pregnancies. Placenta 2024; 149: 29-36. https://doi.org/10.1016/j.placenta.2024.03.001

  16. Diguisto C, Le Gouge A, Marchand MS, et al. Low-dose aspirin to prevent preeclampsia and growth restriction in nulliparous women identified by uterine artery Doppler as at high risk of preeclampsia: A double blinded randomized placebo-controlled trial. PLoS One 2022; 17 (10): e0275129. https://doi.org/10.1371/journal.pone.0275129

  17. Amodeo S, Cavoretto PI, Seidenari A, et al. Second trimester uterine arteries pulsatility index is a function of placental pathology and provides insights on stillbirth aetiology: A multicenter matched case-control study. Placenta 2022; 121: 7-13. https://doi.org/10.1016/j.placenta.2022.02.021

  18. Carranza-Lira S, Jaime-Barrera G, Rosales-Ortiz S, et al. [Brachial and uterine arteries Doppler in healthy women and with preeclampsia]. Rev Med Inst Mex Seguro Soc 2018; 56 (4): 360-3

  19. Chilumula K, Saha PK, Muthyala T, et al. Prognostic role of uterine artery Doppler in early- and late-onset preeclampsia with severe features. J Ultrasound 2021; 24 (3):303-10. https://doi.org/10.1007/s40477-020-00524-0

  20. Chirilă CN, Mărginean C, Ghiga DV, et al. A second trimester prediction algorithm for early-onset hypertensive disorders of pregnancy occurrence and severity based on soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine doppler ultrasound in women at risk. Children (Basel) 2024; 11 (4). https://doi.org/10.3390/children11040468

  21. Abdel Razik M, Mostafa A, Taha S, et al. Combined Doppler ultrasound and platelet indices for prediction of preeclampsia in high-risk pregnancies. J Matern Fetal Neonatal Med 2019; 32 (24): 4128-32. https://doi.org/10.1080/14767058.2018.1481953

  22. Molina Pérez CJ, Nolasco Leaños AG, Carrillo Juárez RI, et al. Soluble Endoglin and Uterine Artery Flow Doppler Ultrasonography as Markers of Progression to Preeclampsia in Women with Gestational Hypertension. Gynecol Obstet Invest 2021; 86 (5): 445-53. https://doi.org/10.1159/000519371

  23. Lai J, Syngelaki A, Nicolaides KH, et al. Using ultrasound and angiogenic markers from a 19- to 23-week assessment to inform the subsequent diagnosis of preeclampsia. Am J Obstet Gynecol. 2022; 227 (2): 294.e1-.e11. https://doi.org/10.1016/j.ajog.2022.03.007

  24. Običan SG, Odibo L, Tuuli MG, et al. Third trimester uterine artery Doppler indices as predictors of preeclampsia and neonatal small for gestational age. J Matern Fetal Neonatal Med. 2020; 33 (20): 3484-9. https://doi.org/10.1080/14767058.2019.1575804

  25. Kale RM, Tirupathi RG, Sheela SR. Role of Ultrasonography and Color Doppler in the Assessment of High-Risk Pregnancies and Their Accuracy in Predicting Fetal Outcome. Cureus. 2023; 15 (5): e39017. https://doi.org/10.7759/cureus.39017

  26. Rodriguez-Fernandez JJ, Martinez-Garza LE, Sepulveda-Gonzalez G, et al. Serum biomarkers and Doppler pulsatile index increases likelihood ratio for prediction of preeclampsia in the second trimester of pregnancy. J Obstet Gynaecol. 2022; 42 (6): 1722-7. https://doi.org/10.1080/01443615.2022.2035331

  27. Ashwal E, Ali-Gami J, Aviram A, et al. Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications. J Clin Med. 2022; 11 (22). https://doi.org/10.3390/jcm11226759

  28. Hasija A, Balyan K, Debnath E, et al. Prediction of hypertension in pregnancy in high risk women using maternal factors and serial placental profile in second and third trimester. Placenta. 2021; 104: 236-42. https://doi.org/10.1016/j.placenta.2021.01.005

  29. Meroni A, Mascherpa M, Minopoli M, et al. Is mid-gestational uterine artery Doppler still useful in a setting with routine first-trimester pre-eclampsia screening? A cohort study. Bjog. 2023; 130 (9): 1128-34. https://doi.org/10.1111/1471-0528.17441

  30. Stoenescu M, Serbanescu MS, Dijmarescu AL, et al. Doppler Uterine Artery Ultrasound in the Second Trimester of Pregnancy to Predict Adverse Pregnancy Outcomes. Curr Health Sci J. 2021; 47 (1): 101-6. https://doi.org/10.12865/chsj.47.01.16




2020     |     www.medigraphic.com