EVALUATING THE PREDICTIVE EFFICACY OF FIRST-TRIMESTER UTERINE ARTERY DOPPLER IN IDENTIFYING ADVERSE PREGNANCY OUTCOMES
Main Article Content
Keywords
Uterine artery Doppler, Pulsatility Index, Pre-eclampsia, Fetal Growth Restriction, First trimester screening, Pregnancy outcomes
Abstract
Background: Early identification of high-risk pregnancies is essential to reduce maternal and fetal morbidity and mortality. Pre-eclampsia (PE) and fetal growth restriction (FGR) are major contributors to adverse outcomes and are often linked to impaired placentation. First-trimester uterine artery Doppler ultrasonography provides a non-invasive assessment of uteroplacental perfusion and may serve as a useful screening tool.
Objective: To evaluate the predictive value of first-trimester uterine artery Doppler parameters—particularly Pulsatility Index (PI) and early diastolic notch—in forecasting adverse pregnancy outcomes including PE, FGR, low birth weight (LBW), preterm delivery, and oligohydramnios.
Methods: A prospective cohort study was conducted on 121 antenatal women between 11 and 13+6 weeks of gestation. Uterine artery Doppler was performed to measure PI and detect early diastolic notching. Participants were followed until delivery, and pregnancy outcomes were documented. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, and Youden Index.
Results: Elevated PI (>2.4) was observed in 26.4% of participants; early diastolic notch was detected in 2.5%. Adverse outcomes occurred in 19.8% of cases, with PE in 12.4%, FGR in 6.6%, LBW in 13.2%, preterm delivery in 12.4%, and oligohydramnios in 8.3%. PI >2.59 predicted PE with 60% sensitivity and 85.8% specificity. PI >2.22 predicted FGR with 100% sensitivity and 63.7% specificity. The highest Youden Index was observed for FGR (0.64) and oligohydramnios (0.51). The presence of early diastolic notch was significantly associated with FGR, LBW, and preterm birth.
Conclusion: First-trimester uterine artery Doppler is a valuable screening modality for predicting adverse pregnancy outcomes, particularly placenta-mediated disorders such as PE and FGR. Elevated PI and early diastolic notch are reliable indicators of impaired placentation and should be integrated into routine antenatal screening protocols to enhance early risk stratification, especially in resource-limited settings.
References
2. Early pathways, biomarkers, and four distinct molecular subclasses of preeclampsia: The intersection of clinical, pathological, and high dimensional biology studies. (2022). [Review]. PubMed
3. “Classification of preeclampsia according to molecular clusters with the goal of achieving personalized prevention.” (2023). [PubMed summary]. PubMed
4. Ghaemi, M. S., Tarca, A. L., Romero, R., Stanley, N., Fallahzadeh, R., Tanada, A., … et al. (2022). Proteomic signatures predict preeclampsia in individual cohorts but not across cohorts—implications for clinical biomarker studies. Journal of Maternal Fetal & Neonatal Medicine, 35(22), 5621–5628. MDPI
5. Schuermans, A., Truong, B., Ardissino, M., Bhukar, R., Slob, E. A. W., Nakao, T., … et al. (2024). Genetic Associations of Circulating Cardiovascular Proteins with Gestational Hypertension and Preeclampsia. JAMA Cardiology, 9(3), 209–220. MDPI
6. Functional bioinformatics study: “Mechanistic study of pre eclampsia and macrophage associated molecular networks: bioinformatics insights from multiple datasets.” (2024). Frontiers in Genetics. Frontiers
7. Hereditas (2025). Identification of immune related genes and molecular subtypes associated with preeclampsia via bioinformatics analysis and experimental validation. Hereditas. Nature+14BioMed Central+14American Heart Association Journals+14
8. “Proteome Based Maternal Plasma and Serum Biomarkers for Preeclampsia: A Systematic Review and Meta Analysis” (2024). Identified complement components (C4b, Factor B, prothrombin) as consistently altered first trimester markers. MDPI – Life Sciences Wikipedia+2MDPI+2MDPI+2
9. Winkelmann, M., Torres Torres, J., Espino Y Sosa, S., Martinez Portilla, R., Borboa Olivares, H., Estrada Gitierrez, G., … et al. (2024). A narrative review on the pathophysiology of preeclampsia. International Journal of Molecular Sciences, 25, 7569. MDPI
10. Westerberg, A. C., Degnes, M. L., Andresen, I. J., Roland, M. C. P., Michelsen, T. M. (2024). Angiogenic and vasoactive proteins at the maternal fetal interface in healthy pregnancies and preeclampsia. American Journal of Obstetrics and Gynecology, 231, 550.e1–550.e22. MDPI
11. Fantasia, A., et al. (2022). Current practice in the diagnosis and management of fetal growth restriction: An international survey. Acta Obstetricia et Gynecologica Scandinavica. Obstetrics & Gynecology
12. Lee, A. C., Cherkerzian, S., Tofail, F., et al. (2024). Perinatal inflammation, fetal growth restriction, and long term neurodevelopmental impairment in Bangladesh. Pediatric Research. https://doi.org/10.1038/s41390 024 03101 x Nature
13. Sehmar, V. L., Mahan, V. L. & others (2025). Correlation and clinical significance of placental tissue selectin (E), angiotensin II and oxidized lipids in preeclampsia. Journal of Medical Biochemistry, 44(1), 148–155. American Heart Association Journals
14. Jawad, W. K., Kadhim, A. M., Issa, A. M., Zabibah, R. S. (2024). New Preeclampsia Calculated Factor (PF) detecting severity across healthy, mild and severe cases. Research Journal of Pharmacy and Technology. American Heart Association Journals
15. Le, Q. A., Akhter, R., Coulton, K. M., Vo, N. T. N., Duong, L. T. Y., Nong, H. V., … Nanan, R. (2021). Periodontitis and preeclampsia in pregnancy: A systematic review and meta analysis. ARXIV preprint. arXiv
16. Callahan, T. J., Stefanski, A. L., Kim, J. D., et al. (2022). Knowledge driven mechanistic enrichment of the preeclampsia ignorome. ARXIV preprint. arXiv
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Sidra Mansoor
Junior Resident Department of Obstetrics and Gynaecology, Hind Institute of Medical Sciences (HIMS), Safedabad, Barabanki, Lucknow, Uttar Pradesh, India
Neha Sahu
Assistant Professor, Department of Obstetrics and Gynaecology,Hind Institute of Medical Sciences (HIMS), Safedabad, Barabanki, Lucknow, Uttar Pradesh, India
Varsha Kumari
Assistant Professor, Department of Obstetrics and Gynaecology, Hind Institute of Medical Sciences (HIMS), Safedabad, Barabanki, Lucknow, Uttar Pradesh, India
Anjana Agarwal
Professor(HOD), Department of Obstetrics and Gynaecology, Hind Institute of Medical Sciences (HIMS), Safedabad, Barabanki, Lucknow, Uttar Pradesh, India
Rinki Kumari
Scientific Officer, Institute of Medical Sciences, Banaras Hindu University (IMS-BHU), Varanasi, Uttar Pradesh, India – 221001.