Publication:

Prediction of pre-eclampsia at 11-14 weeks of pregnancy using mean arterial pressure, uterine artery Doppler and pregnancy-associated plasma protein-A

Background The possibility of prediction of preeclampsia (PE) at 11-14 weeks of pregnancy is a fairly new concept and in recent years, studies combining various parameters at 11-14 weeks of pregnancy have been undertaken, but an algorithm with a high predictive value is yet to be developed. The objective of this study was to develop such a protocol using mean arterial pressure (MAP), uterine artery Doppler and PAPP-A (pregnancy associated plasma protein-A) at 11-14 weeks of pregnancy (individually or in combination) for prediction of preeclampsia in a developing country like India.

Methods A prospective cohort study was done at the Department of Obstetrics and Gynecology, King George Medical University, Lucknow, Uttar Pradesh with pregnant women attending the antenatal OPD at 11- 14 weeks of gestation. A preformed questionnaire was filled for the enrolled women, MAP, blood pressure was recorded, uterine artery Doppler was done, serum sample for PAPP-A was drawn. Uterine artery Doppler pulsatility index (PI) at 11-14 weeks of pregnancy was found to be a good screening method (sensitivity-75.9%, specificity-79.6% at cut-off of 1.7) for prediction of preeclampsia and IUGR. The data was analyzed using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software.

Results Out of the 78 women enrolled, 29 women (37.18%) developed complications. Uterine artery Doppler pulsatility index (PI) at 11-14 weeks of pregnancy was found to be a good screening method (sensitivity-75.9%, specificity-79.6%) for prediction of preeclampsia and IUGR. Presence of early diastolic notch on uterine artery Doppler was found predictive for IUGR. MAP and PAPP-A were not found to have a significant correlation with development of these complications.

Conclusions This study concluded that uterine artery Doppler alone was a good screening method at 11-14 weeks of gestation for women at high risk of developing preeclampsia and related complications.