Uterine Artery Doppler Screening in 2nd Trimester of Pregnancy for Prediction of Pre-eclampsia and Fetal Growth Restriction

Background: Pre-eclampsia is a pregnancy specific disorder characterized by hypertension and proteinuria after 20 weeks of gestation. Uterine artery Doppler velocimetry analysis has been extensively studied in the second trimester of pregnancy as a predictive investigation for the future development of pre-eclampsia and Fetal Growth Restriction.

Aims: To predict the probability of developing pre-eclampsia of pregnant women and Fetal Growth Restriction in relation with normal and abnormal Doppler velocimetry of uterine artery at 2nd trimester of pregnancy.

Methods: A total of 97 pregnant women of 2nd trimester of pregnancy were included in this study. After taking informed written consent of the participants, all they underwent uterine artery Doppler velocimetry at 22nd and 24th week of pregnancy. They again examined clinically during delivery at different gestational age. Pre-eclampsia (PE) was diagnosed on the basis of measurement of blood pressure as well as urine routine and microscopic examination. Fetal Growth Restriction (FGR) was determined by measuring birth weight and gestational age at the time of delivery. Development of PE and FGR was observed in relation to severity of Uterine Artery Doppler Velocimetry findings. A pre-structured data collection sheet was used as a research tool for data collection. Statistical analyses of the results were obtained by using windows-based computer software devised with Statistical Packages for Social Sciences (SPSS-23).

Results: More than half (52.6%) of the subjects belonged to age 21-25 years and 52(53.6%) subjects were nulliparous. More than half (56.7%) of the subjects came from low income group family. Pre-eclampsia developed 11(11.3%) of the patients, 15(15.5%) had FGR and 12(12.4%) had notching in 2nd UADV at 24th week. Presence of Pre-diastolic notch in 2nd UADV study at 24th week to predict pre-eclampsia has sensitivity 72.7%, specificity 95.4%, accuracy 92.8% and positive predictive values 66.7% and negative predictive value 96.5%. Presence of Pre-diastolic notch in 2nd UADV study at 24th week to predict FGR has sensitivity 20.0%, specificity 89.0%, accuracy 78.4% and positive predictive values 25.0% and negative predictive value 85.9%. The mean age was 28.69±7.81 years who had per-diastolic notch in 2nd UADV at 24th week and 24.13±6.11 years who had normal UADV and the p value is 0.022 which is significant. The mean para was 1.29±0.33 who had per-diastolic notch in 2nd UADV at 24th week and 1.77±0.29 who had normal UADV together with remarkable p value which is 0.001. The mean BMI was 23.59±1.09 Kg/m2 who had per-diastolic notch in 2nd UADV at 24th week and 21.57±0.47 Kg/m2 who had normal UADV with notable p value 0.001 in this study.

Conclusion: Uterine artery Doppler velocimetry in early pregnancy can be a good investigating tool for prediction of subsequent development of pre-eclampsia and Fetal Growth Restriction.