PoCUS UtA-PI as a predictor of preeclampsia: Risk of maternal death in low-resource settings
Abstract
The objective of this study was to evaluate the potential of Point-of-care Doppler ultrasound (PoCUS) at the “bedside” of the first-trimester uterine artery for early prediction of preeclampsia (PE) in at-risk pregnant women in low-resource settings. This was a prospective longitudinal study, including 42 pregnant women. The potential of pulsatility indices (PI) is evaluated as a tool for the detection of preeclampsia. Uterine artery Doppler examination performed early at 11–14 GW allows detection of pregnancies that will develope PE with a sensitivity of 78% and a specificity of 100% based on PI analysis. Doppler examination of the uterine artery is an effective non-invasive screening test for the development of PE in high-risk pregnancies, particularly appropriate in health systems with limited means of evaluating other biomarkers such as type A health centers and rural settings.Downloads
References
Filipek A, Jurewicz E. Preeklampsja – choroba kobiet w ciąży. Postępy Biochemii. 2018 Dec 29;64(4):232–229.
Mayrink J, Costa ML, Cecatti JG. Preeclampsia in 2018: Revisiting Concepts, Physiopathology, and Prediction. The Scientific World Journal. 2018 Dec 6; 2018:1–9.
Myatt L, Roberts JM. Preeclampsia: Syndrome or Disease? Current Hypertension Reports. 2015 Nov 11;17(11):83.
Poon LCY, Kametas NA, Chelemen T, Leal A, Nicolaides KH. Maternal risk factors for hypertensive disorders in pregnancy: a multivariate approach. Journal of Human Hypertension. 2010 Feb 11;24(2):104–10.
Odibo AO, Goetzinger KR, Odibo L, Cahill AG, Macones GA, Nelson DM, et al. First-trimester prediction of preeclampsia using metabolomic biomarkers: a discovery phase study. Prenatal Diagnosis. 2011 Oct; 31(10):990–4.
Kenny LC, Black MA, Poston L, Taylor R, Myers JE, Baker PN, et al. Early Pregnancy Prediction of Preeclampsia in Nulliparous Women, Combining Clinical Risk and Biomarkers. Hypertension. 2014 Sep;64(3):644–52.
Andrietti S, Silva M, Wright A, Wright D, Nicolaides KH. Competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 35-37 weeks’ gestation. Ultrasound in Obstetrics & Gynecology. 2016 Jul;48(1):72–9.
Tarca AL, Romero R, Benshalom-Tirosh N, Than NG, Gudicha DW, Done B, et al. The prediction of early preeclampsia: Results from a longitudinal proteomics study. PLOS ONE. 2019 Jun 4;14(6):e0217273.
Chávez J, Cavalli R. Preeclampsia: Vascular Pathophysiological Mechanism and the Basis for Early Diagnosis and Treatment. Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics. 2016 Sep 8;38(08):369–72.
Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019 Jul 15;l2381.
Ayoubi. Pre-eclampsia: pathophysiology, diagnosis, and management. Vascular Health and Risk Management. 2011 Jul;467.
O’Gorman N, Nicolaides KH, Poon LC. The Use of Ultrasound and other Markers for Early Detection of Preeclampsia. Women’s Health. 2016 Mar 1;12(2):199–207.
Yapa HM, Bärnighausen T. Implementation science in resource-poor countries and communities. Implementation Science. 2018 Dec 27;13(1):154.
Espinoza J, Kusanovic JP, Bahado-Singh R, Gervasi MT, Romero R, Lee W, et al. Should Bilateral Uterine Artery Notching Be Used in the Risk Assessment for Preeclampsia, Small-for-Gestational-Age, and Gestational Hypertension? Journal of Ultrasound in Medicine. 2010 Jul;29(7):1103–15.
Giordano R, Cacciatore A, Romano M, la Rosa B, Fonti I, Vigna R. Uterine artery Doppler flow studies in obstetric practice. J Prenat Med. 2010 Oct;4(4):59–62.
Park YW, Lim JC, Kim YH, Kwon HS. Uterine Artery Doppler Velocimetry During Mid-second Trimester to Predict Complications of Pregnancy Based on Unilateral or Bilateral Abnormalities. Yonsei Medical Journal. 2005;46(5):652.
Parry S, Sciscione A, Haas DM, Grobman WA, Iams JD, Mercer BM, et al. Role of early second-trimester uterine artery Doppler screening to predict small-for-gestational-age babies in nulliparous women. American Journal of Obstetrics and Gynecology. 2017 Nov;217(5):594.e1-594.e10.
Sibai B. Diagnosis and Management of Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology. 2003 Jul;102(1):181–92.
Butterfly Network. Especificaciones del sistema – Butterfly Network [Internet]. 2022 [cited 2022 Apr 29]. Available from: https://support.butterflynetwork.com/hc/es-es/articles/360041783912-Especificaciones-del-sistema
The Fetal Medicine Foundation [Internet]. [cited 2022 May 10]. Available from: https://fetalmedicine.org/research/assess/preeclampsia/first-trimester
Gómez O, Martínez JM, Figueras F, del Río M, Borobio V, Puerto B, et al. Uterine artery Doppler at 11–14 weeks of gestation to screen for hypertensive disorders and associated complications in an unselected population. Ultrasound in Obstetrics and Gynecology [Internet]. 2005; 26(5):490–4. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/uog.1976
Becker R, Vonk R, Vollert W, Entezami M. Doppler sonography of uterine arteries at 20-23 weeks: Risk assessment of adverse pregnancy outcome by quantification of impedance and notch. Journal of Perinatal Medicine [Internet]. 2002 Sep 26 [cited 2022 Apr 29];30(5):388–94. Available from: https://www.degruyter.com/document/doi/10.1515/JPM.2002.060/html
Harrington K, Carpenter RG, Goldfrad C, Campbell S. Transvaginal Doppler ultrasound of the uteroplacental circulation in the early prediction of pre-eclampsia and intrauterine growth retardation. BJOG: An International Journal of Obstetrics & Gynaecology [Internet]. 1997 ;104(6):674–81. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.1997.tb11977.x
Harrington K, Goldfrad C, Carpenter RG, Campbell S. Transvaginal uterine and umbilical artery Doppler examination of 12–16 weeks and the subsequent development of pre-eclampsia and intrauterine growth retardation. Ultrasound in Obstetrics and Gynecology [Internet]. 1997; 9(2):94–100. Available from: https://onlinelibrary.wiley.com/doi/full/10.1046/j.1469-0705.1997.09020094.x
Pijnenborg R, Robertson WB, Brosens I, Dixon G. Review article: Trophoblast invasion and the establishment of haemochorial placentation in man and laboratory animals. Placenta. 1981 Jan 1;2(1):71–91.
Jauniaux E, Jurkovic D, Campbell S. In vivo investigations of the anatomy and the physiology of early human placental circulations. Ultrasound in Obstetrics and Gynecology [Internet]. 1991;1(6):435–45. Available from: https://onlinelibrary.wiley.com/doi/full/10.1046/j.1469-0705.1991.01060435.x
Campbell S. First-trimester screening for pre-eclampsia. Ultrasound in Obstetrics and Gynecology [Internet]. 2005; 26(5):487–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/uog.2591
Hafner DE, Schuchter K, Metzenbauer M, Philipp K. Uterine artery Doppler perfusion in the first and second pregnancies. Ultrasound in Obstetrics and Gynecology [Internet]. 2000; 16(7):625–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1046/j.1469-0705.2000.00290.x
Harrington K, Fayyad A, Thakur V, Aquilina J. The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women. Ultrasound in Obstetrics and Gynecology [Internet]. 2004; 23(1):50–5. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/uog.932
Ness RB, Roberts JM. Heterogeneous causes constituting the single syndrome of preeclampsia: A hypothesis and its implications. American Journal of Obstetrics & Gynecology [Internet]. 1996; 175(5):1365–70. Available from: http://www.ajog.org/article/S000293789670056X/fulltext
Aardema MW, Saro MCS, Lander M, de Wolf BTHM, Oosterhof H, Aarnoudse JG. Second trimester Doppler ultrasound screening of the uterine arteries differentiates between subsequent normal and poor outcomes of hypertensive pregnancy: two different pathophysiological entities? Clinical Science [Internet]. 2004; 106(4):377–82. Available from: /clinsci/article/106/4/377/67784/Second-trimester-Doppler-ultrasound-screening-of
Prefumo F, Sebire NJ, Thilaganathan B. Decreased endovascular trophoblast invasion in first trimester pregnancies with high‐resistance uterine artery Doppler indices. Human Reproduction [Internet]. 2004;19(1):206–9. Available from: https://academic.oup.com/humrep/article/19/1/206/690189
Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler at 11–14 weeks of gestation. Ultrasound in Obstetrics and Gynecology [Internet]. 2001; 18(6):583–6. Available from: https://onlinelibrary.wiley.com/doi/full/10.1046/j.0960-7692.2001.00594.x
Pilalis A, Souka AP, Antsaklis P, Basayiannis K, Benardis P, Haidopoulos D, et al. Screening for pre-eclampsia and small for gestational age fetuses at the 11–14 weeks scan by uterine artery Dopplers. Acta Obstetricia et Gynecolóica Scandinavica [Internet]. 2007;86(5):530–4. Available from: https://onlinelibrary.wiley.com/doi/full/10.1080/00016340601155056
Hollis B, Prefumo F, Bhide A, Rao S, Thilaganathan B. First-trimester uterine artery blood flow and birth weight. Ultrasound in Obstetrics and Gynecology. 2003; 22(4):373–6. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/uog.231
Gómez O, Figueras F, Martínez JM, del Río M, Palacio M, Eixarch E, et al. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound in Obstetrics and Gynecology [Internet]. 2006; 28(6):802–8. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/uog.2814
Melchiorre K, Leslie K, Prefumo F, Bhide A, Thilaganathan B. First-trimester uterine artery Doppler indices in the prediction of small-for-gestational age pregnancy and intrauterine growth restriction. Ultrasound in Obstetrics and Gynecology [Internet]. 2009; 33(5):524–9. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/uog.6368
Melchiorre K, Wormald B, Leslie K, Bhide A, Thilaganathan B. First-trimester uterine artery Doppler indices in term and preterm pre-eclampsia. Ultrasound in Obstetrics and Gynecology [Internet]. 2008; 32(2):133–7. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/uog.5400
Carbillon L, Uzan M, Largillière C, Perrot N, Tigaizin A, Paries J, et al. Prospective Evaluation of Uterine Artery Flow Velocity Waveforms at 12–14 and 22–24 Weeks of Gestation in Relation to Pregnancy Outcome and Birth Weight. Fetal Diagnosis and Therapy [Internet]. 2004;19(4):381–4. Available from: https://www.karger.com/Article/FullText/77971
Copyright (c) 2022 FACSALUD-UNEMI
![Creative Commons License](http://i.creativecommons.org/l/by-nc-nd/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Todos los artículos de la Revista FACSalud UNEMI son difundidos bajo licencia internacional Creative Commons Reconocimiento-NoComercial-SinObrasDerivadas 4.0.
Los autores mantienen los derechos de autor, y, por lo tanto, son libres de compartir, copiar, distribuir, ejecutar y comunicar públicamente la obra bajo las condiciones siguientes: Reconocer los créditos de la obra especificada por el autor e indicar si se realizaron cambios (puede hacerlo de cualquier forma razonable, pero no de una manera que sugiera que el autor respalda el uso que hace de su obra. No utilizar la obra para fines comerciales. En caso de remezcla, transformación o desarrollo, no puede distribuirse el material modificado.