First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications

Abstract

Uterine artery Doppler waveform analysis has been extensively studied in the second trimester of pregnancy as a predictive marker for the later development of preeclampsia and fetal growth restriction. The use of Doppler interrogation of this vessel in the first trimester has gained momentum in recent years. Various measurement techniques and impedance indices have been used to evaluate the relationship between uterine artery Doppler velocimetry and adverse pregnancy outcomes. Overall, first-trimester Doppler interrogation of the uterine artery performs better in the prediction of early-onset than late-onset preeclampsia. As an isolated marker of future disease, its sensitivity in predicting preeclampsia and fetal growth restriction in low risk pregnant women is moderate, at 40-70%. Multiparametric predictive models, combining first-trimester uterine artery pulsatility index with maternal characteristics and biochemical markers, can achieve a detection rate for early-onset preeclampsia of over 90%. The ideal combination of these tests and validation of them in various patient populations will be the focus of future research.

Figure 1

Transabdominal Doppler interrogation of the uterine artery at the level of the internal cervical os. Uterine artery waveform demonstrating raised PI with an early diastolic notch (arrow). Reproduced with permission from Associate Professor F. da Silva Costa.

Figure 2

Transvaginal Doppler interrogation of the uterine artery at the cervicocorporeal junction. Normal uterine artery waveforms. Reproduced with permission from Associate Professor F. da Silva Costa.