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Keywords:

  • gestational hypertension;
  • mean arterial pressure;
  • pre-eclampsia;
  • screening;
  • uterine artery Doppler

Abstract

Objectives

To examine the performance of screening for hypertensive disorders in pregnancy at 11–13 weeks by a combination of the maternal history, uterine artery Doppler imaging and blood pressure.

Methods

This was a prospective screening study for pre-eclampsia (PE) requiring delivery before 34 weeks (early PE), late PE and gestational hypertension (GH) in women attending for their routine first hospital visit in pregnancy at 11 + 0 to 13 + 6 weeks of gestation. Maternal history was recorded, color flow Doppler imaging was used to identify the uterine artery with the lowest pulsatility index (L-PI) and automated devices were used to measure the mean arterial pressure (MAP). The performance of screening for PE and GH by a combination of the maternal factor-derived a-priori risk, the uterine artery L-PI and MAP was determined.

Results

There were 8061 (96.4%) cases unaffected by PE or GH, 165 (2.0%) that developed PE including 37 that required delivery before 34 weeks (early PE) and 128 with late PE, and 140 (1.7%) that developed GH. The MAP was higher in early PE, late PE and GH than in the unaffected group (P < 0.0001), and in early PE than in GH (P = 0.002). The uterine artery L-PI was significantly higher in early PE and late PE than in the unaffected group (P < 0.0001), in early PE than late PE or GH (P < 0.0001), and in GH than in the unaffected group (P = 0.014). In screening by a combination of the maternal factor-derived a-priori risk, uterine artery L-PI and MAP, the estimated detection rate at a 10% false-positive rate was 89.2% (95% CI, 74.6–96.9%) for early PE, 57.0% (95% CI, 48.0–65.7%) for late PE and 50.0% (95% CI, 41.4–58.6%) for GH.

Conclusions

Effective screening for hypertensive disorders in pregnancy is provided by a combination of maternal history, uterine artery Doppler imaging and blood pressure at 11–13 weeks. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.