Ultraschall Med 2016; 37 - SL9_2
DOI: 10.1055/s-0036-1587752

Prediction of preeclampsia by maternal carotid intima-media-thickness, blood pressure, flow-mediated dilatation and uterine artery Doppler

A Brückmann 1, C Seeliger 2, T Lehmann 3, D Schlembach 4, E Schleußner 2
  • 1GesaTal Medical Center, Department of Prenatal Diagnosis and Preventive Medicine, Erfurt, Germany
  • 2University Hospital Jena, Friedrich-Schiller-University, Department of Obstetrics, Jena, Germany
  • 3University Hospital Jena, Friedrich-Schiller-University, Institute of Medical Statistics, Jena, Germany
  • 4Vivantes Hospital, Department of Obstetrics, Berlin-Neukölln, Germany

Purpose: To evaluate the performance of a 1st, 2nd and 3 rd trimester (T) prediction model for preeclampsia (PMPE) by a combination of carotid intima media thickness (cIMT), flow-mediated dilatation (FMD), retinal arteriolar-venular ratio (AVR), mean arterial pressure (MAP), and uterine artery (UtA) Doppler.

Methods: We performed the combined screening in 761 pregnant women, of whom 292 were analyzed in the 1st, 475 in the 2nd and 407 in the 3 rd trimester. cIMT and FMD were assessed using high-resolution ultrasound and an automated reading program and AVR was calculated using a specific retinal vessel analyser. All women underwent UtA Doppler ultrasonography and pulsatility index (PI) was used. The areas under (AUC) the receiver operating curves (ROC), detection (DR) and false-positive rates (FPR) for the different PMPEs were calculated: 1stT: cIMT, AVR, MAP, 2nd and 3rdT: cIMT, FMD, UtA-PI, MAP and a PMPE for daily use (PMPEdu): cIMT, MAP and UtA-PI.

Results: The mean maternal age was 31 ± 5 years. 96 women (32 ± 5 years) later developed PE, including 39 early onset, 57 late onset, 10 superimposed early onset and 18 superimposed late onset PE cases. The 3 rd T PMPE yielded the best DR for preeclampsia (90.6%, FPR: 20.3%, AUC: 0.92), followed by the 2nd T PMPE (DR: 76.8%, FPR: 20.3%, AUC: 0.85) and 1st T PMPE (DR: 69%, FPR: 17.1%, AUC: 0.84). The DRs of the PMPEdu were slightly different [1st T (DR: 73.7%, FPR: 16.2, AUC: 0.83), 2nd T (DR: 73.2%, FPR: 19.3%, AUC: 0.85), 3 rd T (DR: 86.8%, FPR 18.9%, AUC: 0.91)

Conclusion: The different combinations of cIMT, FMD, UtA-PI, MAP and AVR were better 1st, 2nd and 3 rd trimester predictors of preeclampsia than any individual marker. Since the combination of cIMT, MAP and UtA-PI provides similar results it could serve as an easy preeclampsia prediction tool for daily use.