Screening for pre-eclampsia and small for gestational age fetuses at the 11-14 weeks scan by uterine artery Dopplers

Abstract

Objective: To assess the role of uterine artery Doppler studies at 11-14 weeks in screening for pre-eclampsia (PET), small for gestational age (SGA) fetuses, and placental abruption.

Methods: Prospective study on 1,123 women presenting for routine ultrasound examination at 11-14 weeks for nuchal translucency measurement. Uterine artery blood flow was studied by transvaginal colour Doppler, the mean pulsatility index (PI) was calculated, and the presence of a diastolic notch was recorded.

Results: The mean, median and 95th centile of uterine artery PI were 1.71, 1.64 and 2.54, respectively. Bilateral notches were observed in 63.4%, and a unilateral notch in 18.4% of cases. The sensitivity of mean uterine artery PI>or=95th centile for PET, early onset severe PET necessitating delivery before 34 weeks, SGA<or=5th centile, SGA necessitating delivery before 34 weeks, SGA<or=10th centile and placental abruption were 21.4, 33.3, 17.8, 100, 9.6 and 44.4%, respectively. One in 6 women with increased resistance in the uterine arteries at 11-14 weeks will develop a complication related to utero-placental insufficiency.

Conclusions: Abnormal uterine Dopplers at 11-14 weeks identified one-third of women with severe early onset pre-eclampsia, all fetuses with SGA<or=5th centile that were delivered at<or=34 weeks, and 40% of cases with placental abruption. Uterine artery Doppler examination at the 11-14 weeks scan can identify a high risk population in which preventive or therapeutic interventions might be effective.