THE IMPACT OF UTERINE ARTERY DOPPLER ASSESSMENT AT 11-13+6 WEEKS GESTATIONAL AGE ON STRATIFICATION OF EARLY ONSET PREECLAMPSIA AT A TERTIARY CARE TEACHING HOSPITAL IN NORTH INDIA
Main Article Content
Keywords
Preeclampsia, uterine artery Pulsatility index, Mean arterial pressure
Abstract
- : Clinical history alone that is used to stratify risk to develop preterm preeclampsia in pregnant women may overestimate the number of pregnant women that need preventative therapy with low dose aspirin. Integration of mean arterial blood pressure (MAP) and mean uterine artery pulsatility index (mean UtA PI) Doppler studies with clinical history can reduce the proportion of women identified at high risk and consequently started on low dose aspirin.
- Aim: The purpose of this study was to quantify the difference in the proportion of women identified at high risk for preterm PE using a combined screening model and clinical history alone model.
- Materials and methods: A cross sectional study of pregnant women screened between 11-13+6 gestational weeks included clinical history, mean arterial blood pressure measurements (MAP) and mean uterine artery pulsatility index (Mean UtA PI) using fetal Doppler assessment for all enrolled women. An individualized risk for preterm preeclampsia based on clinical history alone and risk based on clinical history combined with MAP and Mean UtA PI was determined using a cutoff of 1 in 150 and the Fetal Medicine Foundation online calculator. The difference in the proportion of high-risk women using these two strategies was determined and a pairwise correlation test to correlate the two risk scores.
- Results: The study included 49 pregnant women screened between 11-13+6 gestational weeks from March to September 2025. Screening by clinical history alone identified 36 (73.47%) first trimester women at high risk compared to 19 (38.78%) pregnant women identified at high risk using the combined screening model (p=0.0006).The pairwise correlation (0.28) of risk scores by history alone and the combined screening model was poor.
Conclusions: The integration of MAP and Mean UtA PI with clinical history will significantly reduce the number of women identified at high risk for preterm PE and consequently reduce the number of women that must be provided low dose aspirin and need more frequent surveillance. This will reduce the strain on health care infrastructure and economic strain on patients
References
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20. Parra-Cordero M, Rodrigo R, Barja P, Bosco C, Rencoret G, Sepúlveda-Martinez A, et al. Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during the first trimester of pregnancy. Ultrasound ObstetGynecol. 2013:41:538–544. doi: 10.1002/uog.12264.
21. Kho EM, McCowan LM, North RA, Roberts CT, Chan E, Black MA, et al; SCOPE Consortium. Duration of sexual relationship and its effect on preeclampsia and small for gestational age perinatal outcome.JReprod Immunol. 2009;82:66–73. doi: 10.1016/j.jri.2009.04.011.
22. Verwoerd GR, Hall DR, Grové D, Maritz JS, Odendaal HJ. Primipaternity and duration of exposure to sperm antigens as risk factors for pre-eclampsia.Int J Gynaecol Obstet. 2002;78:121–126.
23. Saftlas AF, Levine RJ, Klebanoff MA, Martz KL, Ewell MG, Morris CD, et al Abortion, changed paternity, and risk of preeclampsia in nulliparouswomen. Am J Epidemiol. 2003;157:1108–1114.
24. Skjaerven R, Wilcox AJ, Lie RT. The interval between pregnancies and the risk of preeclampsia. N Engl J Med. 2002;346:33–38.
25. Lykke JA, Bare LA, Olsen J, Lagier R, Arellano AR, Tong C, et al. Thrombophilias and adverse pregnancy outcomes: results from the Danish National Birth Cohort. J ThrombHaemost.2012;10:1320–1325. doi: 10.1111/j.1538-7836.2012.04773.x.
26. Al-Rubaie Z, Askie LM, Ray JG, Hudson HM, Lord SJ. The performance of risk prediction models for pre-eclampsia using routinely collected maternal characteristics and comparison with models that include specialised tests and with clinical guideline decision rules: a systematic review.BJOG.2016;123:1441–1452. doi: 10.1111/1471-0528.14029.
27. Poon LC, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11-13 weeks' gestation. Fetal Diagn Ther. 2012;31(1):42-8. doi: 10.1159/000335366. Epub 2012 Jan 13. PMID: 22248988.
28. O’Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M,et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol. 2017;49:756–760. doi:10.1002/uog.17455.
29. Choorakuttil RM, Patel H, Bavaharan R, Devarajan P, Kanhirat S, Shenoy RS, et al. Samrakshan: An Indian Radiological and Imaging Association program to reduce perinatal mortality in India. Indian J Radiol Imaging. 2019 Oct-Dec;29(4):412-417. doi: 10.4103/ijri.IJRI_386_19.
30. Choorakuttil RM, Rajalingam B, Satarkar SR, Sharma LK, Gupta A, Baghel A, et al. Reducing Perinatal Mortality in India: Two-Years Results of the IRIA Fetal Radiology Samrakshan Program. Indian J Radiol Imaging. 2022 Apr 19;32(1):30-37. doi: 10.1055/s-0041-1741087.
31. Choorakuttil RM, Rajalingam B, Satarkar SR, Sharma LK, Gupta A, Baghel A, et al. Effectiveness of the First Trimester Samrakshan Protocol for the Identification of Pregnant Women at High Risk for Preterm Pre-eclampsia. Indian J Radiol Imaging. 2022 Dec 26;33(1):98-100. doi: 10.1055/s-0042-1759856.
32. ACOG. First-trimester risk assessment for early-onset preeclampsia. Committee opinion No. 638. Obstet Gynecol 2015; 126: e25–27.
33. Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J Obstet Gynecol 2015; 213: 62.e1–10.
34. O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, Wright A, Accuracy of competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks' gestation. Ultrasound Obstet Gynecol 2017; 49: 751–755.
35. Tousty P, Czuba B, Borowski D, Fraszczyk-Tousty M, Dzidek S, Kwiatkowska E, et al. Effectiveness of Different Algorithms and Cut-off Value in Preeclampsia First Trimester Screening. J Pregnancy. 2022 Apr 8;2022:6414857. doi: 10.1155/2022/6414857. PMID: 35433048; PMCID: PMC9012645.
36. Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011; 29: 183–196.
37. Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116: 402–414.
38. Roberge S, Nicolaides K, Demers S, Villa P, Bujold E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2013; 41: 491–499.
39. Roberge S, Villa P, Nicolaides K, Giguère Y, Vainio M, Bakthi A, et al. Early administration of low dose aspirin for the prevention of preterm and term pre-eclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31: 141–146
2. Sotiriadis A, Hernandez-Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, et al; ISUOG CSC Pre-eclampsia Task Force. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet Gynecol. 2019;53(1):7-22. doi: 10.1002/uog.20105. Epub 2018 Oct 15. PMID: 30320479.
3. Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019 May;145 Suppl 1(Suppl 1):1-33. doi: 10.1002/ijgo.12802.
4. Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol 2014; 10: 466–480.
5. Melchiorre K, Sharma R, Thilaganathan B. Cardiovascular implications in preeclampsia: an overview. Circulation 2014; 130: 703–714.
6. Mifsud W, Sebire NJ. Placental pathology in early-onset and late-onset fetal growth restriction. Fetal Diagn Ther 2014; 36: 117–128.
7. Llurba E, Carreras E, Gratacós E, Juan M, Astor J, Vives A, et al. Maternal history and uterine artery Doppler in the assessment of risk for development of early- and late-onset preeclampsia and intrauterine growth restriction. Obstet Gynecol Int. 2009;2009:275613. doi: 10.1155/2009/275613.
8. Stergiotou I, Crispi F, Valenzuela-Alcaraz B, Bijnens B, Gratacos E. Patterns of maternal vascular remodeling and responsiveness in early- versus late-onset preeclampsia. Am J Obstet Gynecol 2013; 209: 558.e1–14.
9. O'Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks gestation. Am J Obstet Gynecol 2016; 214: 103.e1–12.
10. Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017; 377: 613–622.
11. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al; International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension. 2018;72(1):24-43. doi: 10.1161/HYPERTENSIONAHA.117.10803.
12. Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF,et al. Circulating angiogenic factors and the risk of preeclampsia.N Engl J Med. 2004;350:672–683. doi: 10.1056/NEJMoa031884
13. Baweja S, Kent A, Masterson R, Roberts S, McMahon LP. Prediction of pre-eclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high-performance liquid chromatography. BJOG.2011;118:1126–1132. doi: 10.1111/j.1471-0528.2011.02960.x.
14. Kleinrouweler CE, Wiegerinck MM, Ris-Stalpers C, Bossuyt PM, van der Post JA, von Dadelszen P, et al; EBM CONNECT Collaboration. Accuracy of circulating placental growth factor, vascular endothelial growth factor, soluble fms-like tyrosine kinase 1 and soluble endoglin in the prediction of pre-eclampsia: a systematic review and meta-analysis. BJOG.2012;119:778–787. doi: 10.1111/j.1471-0528.2012.03311.x.
15. Di Lorenzo G, Ceccarello M, Cecotti V, Ronfani L, Monasta L, Vecchi Brumatti L, et al. First trimester maternal serum PIGF, free β-hCG, PAPP-A, PP-13, uterine artery Doppler and maternal history for the prediction of preeclampsia. Placenta. 2012;33:495–501.doi: 10.1016/j.placenta.2012.03.003.
16. Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol.2012;119:1234–1242. doi: 10.1097/AOG.0b013e3182571669.
17. Masoura S, Kalogiannidis IA, Gitas G, Goutsioulis A, Koiou E, Athanasiadis A, et al. Biomarkers in pre-eclampsia: a novel approach to early detection of the disease. J ObstetGynaecol. 2012;32:609–616.
18. Bartsch E, Medcalf KE, Park AL, Ray JG; High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohortstudies. BMJ. 2016;353:i1753. doi: 10.1136/bmj.i1753.
19. North RA, McCowan LM, Dekker GA, Poston L, Chan EH, Stewart AW, et al. Clinical risk prediction for pre-eclampsia in nulliparous women: development of model ininternational prospective cohort. BMJ. 2011;342:d1875.
20. Parra-Cordero M, Rodrigo R, Barja P, Bosco C, Rencoret G, Sepúlveda-Martinez A, et al. Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during the first trimester of pregnancy. Ultrasound ObstetGynecol. 2013:41:538–544. doi: 10.1002/uog.12264.
21. Kho EM, McCowan LM, North RA, Roberts CT, Chan E, Black MA, et al; SCOPE Consortium. Duration of sexual relationship and its effect on preeclampsia and small for gestational age perinatal outcome.JReprod Immunol. 2009;82:66–73. doi: 10.1016/j.jri.2009.04.011.
22. Verwoerd GR, Hall DR, Grové D, Maritz JS, Odendaal HJ. Primipaternity and duration of exposure to sperm antigens as risk factors for pre-eclampsia.Int J Gynaecol Obstet. 2002;78:121–126.
23. Saftlas AF, Levine RJ, Klebanoff MA, Martz KL, Ewell MG, Morris CD, et al Abortion, changed paternity, and risk of preeclampsia in nulliparouswomen. Am J Epidemiol. 2003;157:1108–1114.
24. Skjaerven R, Wilcox AJ, Lie RT. The interval between pregnancies and the risk of preeclampsia. N Engl J Med. 2002;346:33–38.
25. Lykke JA, Bare LA, Olsen J, Lagier R, Arellano AR, Tong C, et al. Thrombophilias and adverse pregnancy outcomes: results from the Danish National Birth Cohort. J ThrombHaemost.2012;10:1320–1325. doi: 10.1111/j.1538-7836.2012.04773.x.
26. Al-Rubaie Z, Askie LM, Ray JG, Hudson HM, Lord SJ. The performance of risk prediction models for pre-eclampsia using routinely collected maternal characteristics and comparison with models that include specialised tests and with clinical guideline decision rules: a systematic review.BJOG.2016;123:1441–1452. doi: 10.1111/1471-0528.14029.
27. Poon LC, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for measurement of mean arterial pressure at 11-13 weeks' gestation. Fetal Diagn Ther. 2012;31(1):42-8. doi: 10.1159/000335366. Epub 2012 Jan 13. PMID: 22248988.
28. O’Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, de Alvarado M,et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol. 2017;49:756–760. doi:10.1002/uog.17455.
29. Choorakuttil RM, Patel H, Bavaharan R, Devarajan P, Kanhirat S, Shenoy RS, et al. Samrakshan: An Indian Radiological and Imaging Association program to reduce perinatal mortality in India. Indian J Radiol Imaging. 2019 Oct-Dec;29(4):412-417. doi: 10.4103/ijri.IJRI_386_19.
30. Choorakuttil RM, Rajalingam B, Satarkar SR, Sharma LK, Gupta A, Baghel A, et al. Reducing Perinatal Mortality in India: Two-Years Results of the IRIA Fetal Radiology Samrakshan Program. Indian J Radiol Imaging. 2022 Apr 19;32(1):30-37. doi: 10.1055/s-0041-1741087.
31. Choorakuttil RM, Rajalingam B, Satarkar SR, Sharma LK, Gupta A, Baghel A, et al. Effectiveness of the First Trimester Samrakshan Protocol for the Identification of Pregnant Women at High Risk for Preterm Pre-eclampsia. Indian J Radiol Imaging. 2022 Dec 26;33(1):98-100. doi: 10.1055/s-0042-1759856.
32. ACOG. First-trimester risk assessment for early-onset preeclampsia. Committee opinion No. 638. Obstet Gynecol 2015; 126: e25–27.
33. Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am J Obstet Gynecol 2015; 213: 62.e1–10.
34. O'Gorman N, Wright D, Poon LC, Rolnik DL, Syngelaki A, Wright A, Accuracy of competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks' gestation. Ultrasound Obstet Gynecol 2017; 49: 751–755.
35. Tousty P, Czuba B, Borowski D, Fraszczyk-Tousty M, Dzidek S, Kwiatkowska E, et al. Effectiveness of Different Algorithms and Cut-off Value in Preeclampsia First Trimester Screening. J Pregnancy. 2022 Apr 8;2022:6414857. doi: 10.1155/2022/6414857. PMID: 35433048; PMCID: PMC9012645.
36. Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011; 29: 183–196.
37. Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116: 402–414.
38. Roberge S, Nicolaides K, Demers S, Villa P, Bujold E. Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet Gynecol 2013; 41: 491–499.
39. Roberge S, Villa P, Nicolaides K, Giguère Y, Vainio M, Bakthi A, et al. Early administration of low dose aspirin for the prevention of preterm and term pre-eclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31: 141–146
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Dec 10, 2025
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Dr. Nivea Jain, Dr. Rajneesh Madhok, & Dr. Sukriti Verma. (2025). THE IMPACT OF UTERINE ARTERY DOPPLER ASSESSMENT AT 11-13+6 WEEKS GESTATIONAL AGE ON STRATIFICATION OF EARLY ONSET PREECLAMPSIA AT A TERTIARY CARE TEACHING HOSPITAL IN NORTH INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(11), 295-306. https://doi.org/10.53555/veb38q55
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Author Biographies
Dr. Nivea Jain
Junior Resident, Department of Radiodiagnosis, Rajshree Medical Research Institute, Bareilly, Niveajain1994@gmail.com
Dr. Rajneesh Madhok
Professor and Head of Department, Department of Radiodiagnosis, Rajshree Medical Research Institute, Bareilly
Dr. Sukriti Verma
Assistant professor, Department of Radiodiagnosis, Rajshree Medical Research Institute, Bareilly
How to Cite
Dr. Nivea Jain, Dr. Rajneesh Madhok, & Dr. Sukriti Verma. (2025). THE IMPACT OF UTERINE ARTERY DOPPLER ASSESSMENT AT 11-13+6 WEEKS GESTATIONAL AGE ON STRATIFICATION OF EARLY ONSET PREECLAMPSIA AT A TERTIARY CARE TEACHING HOSPITAL IN NORTH INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(11), 295-306. https://doi.org/10.53555/veb38q55
