Hypertensive disorders in pregnancy: screening by uterine artery Doppler imaging and blood pressure at 11–13 weeks

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.