European Journal of Molecular & Clinical Medicine

Introduction: Preeclampsia is a multisystem disorder and is a major contributor of maternal and perinatal morbidity and mortality. Identifying women, who are at risk is important to prompt gestational management. Uterine artery waveform and biomarkers like pregnancy-associated plasma protein-A (PAPP-A) may reflect the pathophysiology of preeclampsia.
Aim: We aim to find out whether abnormal uterine artery pulsatility index (PI) and low serum PAPP-A in the first trimester can be used to predict preeclampsia.
Material And Methods: Antenatal women at 11-13⁺⁶ weeks of gestation visiting Sri Guru Ram Das Universty Of Health And science, Amritsar were enrolled after informed consent. Uterine artery Doppler was done with the early anomaly scan at 11-13⁺⁶ weeks. Serum levels of PAPP-A were analyzed. The women were followed up at intervals up to delivery. Incidence of preeclampsia was noted.
RESULTS: The incidence of preeclampsia was 26%. The mean uterine artery PI among those who developed preeclampsia was 2.03, which was significantly higher than the unaffected group (p=0.001). The first-trimester uterine artery PI as a screening tool showed a sensitivity of 84.67% and specificity of 75.68 % .The mean PAPP-A MoM of the affected group was 0.91 which was lower than the unaffected group (p=0.028). The first trimester PAPP-A as a screening tool showed a sensitivity of 15.38%, specificity of 91.89%.
Conclusion: Both the tests were concluded to be good predictors of preeclampsia. Identification of high-risk factors, screening, and surveillance are  important for timely  prediction of  preeclampsia and initiation of preventive therapy.

Background and objectives: Predicting preeclampsia (PE) at 11-14 weeks of gestation is a new concept. Studies integrating multiple factors at 11-14 weeks of pregnancy have been conducted, but an algorithm with a good predictive value has yet to be created. This study aimed to design a methodology combining MAP, Uterine artery Doppler, and PAPPA at 11-14 weeks of pregnancy to predict PE in India. Basically objective is to determine whether higher Mean Arterial Pressure (MAP), increased Uterine Artery Pulsatility Index (UAPI), and low Pregnancy Associated Plasma Protein A (PAPP - A) between weeks 11-14 of pregnancy are linked to the growth of hypertensive diseases in pregnancy.
Method: This is a prospective cohort study. Data were obtained from 200 registered patients attending antenatal OPD in hospitals between 11 and 14 weeks of gestation. MAP, blood pressure, uterine artery Doppler, and serum sample for PAPPA were measured. IBM SPSS Version 22 for Windows was used to analyse the data.
Result: There were a total of 200 women enrolled in the study, and 24 of those women (37.1%) suffered difficulties. At 11-14 weeks of pregnancy, the uterine artery doppler pulsatality index (PI) was found to be an effective screening tool (sensitivity 29%, specificity 90%) for the prediction of pregnancy.
Conclusion: This study revealed that the uterine artery Doppler Pulsatality index is an effective screening approach for women at high risk of developing preeclampsia and related complications during the 11th to 14th week of pregnancy.
 

Background: To determine the clinical value of first trimester and second-trimester
uterine artery Doppler indices in the prediction of adverse pregnancy outcome
(preeclampsia, IUGR, unexplained stillbirths).
Materials &Methods:This was a prospective study in which uterine artery Doppler was
performed at 22-24 weeks of gestation 100 high-risk women attending antenatal OPD at
Dr psims & rf in the first trimester between 11 to 13 weeks6days POG for early
pregnancy scan and uterine artery Doppler, followed with second-trimester uterine
artery doppler at the time of anomaly scan 18 to 20weeks from June 2019 to June 2020.
Results: Among the high-risk women in the present study the risk factors are chronic
hypertension (40%), precious pregnancy (10%), overt DM (12%), previous history of
preeclampsia (15%),RPL(10%),SLE (7%), twins (3%), oligohydramnios (3%).
Abnormal uterine artery Doppler indices had the highest sensitivity (100.0%) for
predicting preeclampsia in the mother and the lowest sensitivity (51.4%) for predicting
preterm. For predicting pre-eclampsia, IUGR, neonatal mortality, preterm the
sensitivity of RI was 100%,85.7%,83.3%,51.4% respectively, and the specificity was
92.3%,100%,95.8%,100% respectively. Overall, 35 (35.0%) women had a preterm
delivery, 16 (36%) had a cesarean delivery, and 19 (61%) had a spontaneous vaginal
delivery. Among the preterms, 18(51.4%) died due to prematurity and its associated
complications. The positive predictive value of abnormal uterine artery Doppler was
highest for preeclampsia (36.84%) among all adverse pregnancy outcomes assessed.
Conclusion: Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a
significant predictor of at least one adverse pregnancy outcome, with the highest
prediction for preeclampsia.