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Archives of Gynecology and Obstetrics

, Volume 300, Issue 6, pp 1559–1564 | Cite as

First trimester uterine artery pulsatility index levels in euploid and aneuploid pregnancies

  • Natalia Prodan
  • Philipp Wagner
  • Jiri Sonek
  • Markus Hoopmann
  • Armin Mutz
  • Sara Brucker
  • Karl Oliver KaganEmail author
Maternal-Fetal Medicine
  • 64 Downloads

Abstract

Objective

To examine whether the uterine artery PI is different in aneuploid and euploid pregnancies.

Methods

Retrospective case-matched study at the department of prenatal medicine at the University of Tuebingen, Germany. The study involved patients with complete data on first trimester screening for trisomies and preeclampsia except PlGF. For each case with trisomy 21 we randomly selected 50 cases with a euploid fetus where complete data on screening for aneuploidy and preeclampsia were also available. The uterine artery pulsatility index and the corresponding MoM values of euploid and the aneuploid population were compared with a Man–Whitney U test.

Results

The dataset consisted of 4591 singleton pregnancies. The karyotype was normal in 4500 cases and was abnormal in the remaining 91 pregnancies. There were 50 pregnancies with trisomy 21, 31 with trisomy 18 and 13, and 10 with triploidy. In the group with euploid fetuses, median uterine artery PI was 1.55 (0.99 MoM). In the group with trisomy 21, the median PI (1.42) and MoM (0.89) levels were both significantly lower than in the euploid (p < 0.001). However, the measurements in the trisomy 18 and 13 [1.61 (0.93 MoM)] and in the triploidy [1.99 (1.13 MoM)] groups were not significantly different from those in the euploid group (p = 0.468 and p = 0.632, respectively).

Conclusion

In conclusion, uterine artery PI levels in the first trimester are slightly lower in pregnancies with trisomy 21. This knowledge may prove to be useful in cases where a low PAPP-A level is seen on the first trimester maternal serum biochemical evaluation to differentiate whether the more likely cause for this finding is placental dysfunction or aneuploidy, specifically trisomy 21.

Keywords

Uterine artery doppler Preeclampsia Trisomy First trimester 

Notes

Author contributions

NP manuscript writing, Data collection and analysis. PW data collection. JS manuscript writing and editing. MH data collection. AM data collection. SB manuscript writing and editing. KOK project development, Data analysis, manuscript writing and editing.

Funding

None.

Compliance with ethical standards

Conflict of interest

All authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This is a retrospective study involving ultrasound images from patients that were seen at the University of Tuebingen, Germany. All patients have agreed that clinical data can be used for retrospective studies. The study was approved by the local ethical committee. This is also stated in the Methods section (No. 350/2019BO2).

References

  1. 1.
    Kagan KO, Sonek J, Wagner P, Hoopmann M (2017) Principles of first trimester screening in the age of non-invasive prenatal diagnosis: screening for chromosomal abnormalities. Arch Gynecol Obstet 296:645–651.  https://doi.org/10.1007/s00404-017-4459-9 CrossRefPubMedGoogle Scholar
  2. 2.
    Kagan KO, Sonek J, Wagner P, Hoopmann M (2017) Principles of first trimester screening in the age of non-invasive prenatal diagnosis: screening for other major defects and pregnancy complications. Arch Gynecol Obstet 31:3–9.  https://doi.org/10.1007/s00404-017-4460-3 CrossRefGoogle Scholar
  3. 3.
    Poon LC, Nicolaides KH (2014) First-trimester maternal factors and biomarker screening for preeclampsia. Prenat Diagn 34:618–627.  https://doi.org/10.1002/pd.4397 CrossRefPubMedGoogle Scholar
  4. 4.
    O'Gorman N, Wright D, Syngelaki A et al (2016) Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks gestation. Am J Obstet Gynecol 214:103.e1–103.e12.  https://doi.org/10.1016/j.ajog.2015.08.034 CrossRefGoogle Scholar
  5. 5.
    Staboulidou I, Galindo A, Maiz N et al (2009) First-trimester uterine artery Doppler and serum pregnancy-associated plasma protein-a in preeclampsia and chromosomal defects. Fetal Diagn Ther 25:336–339.  https://doi.org/10.1159/000235880 CrossRefPubMedGoogle Scholar
  6. 6.
    Snijders R, Noble P, Sebire N et al (1998) UK multicentre project on assessment of risk of trisomy 21 by maternal age and fetal nuchal-translucency thickness at 10–14 weeks of gestation. Lancet 352:343–346.  https://doi.org/10.1016/S0140-6736(97)11280-6 CrossRefPubMedGoogle Scholar
  7. 7.
    Kagan KO, Wright D, Valencia C et al (2008) Screening for trisomies 21, 18 and 13 by maternal age, fetal nuchal translucency, fetal heart rate, free -hCG and pregnancy-associated plasma protein-A. Hum Reprod 23:1968–1975.  https://doi.org/10.1093/humrep/den224 CrossRefPubMedGoogle Scholar
  8. 8.
    Syngelaki A, Chelemen T, Dagklis T et al (2011) Challenges in the diagnosis of fetal non-chromosomal abnormalities at 11–13 weeks. Prenat Diagn 31:90–102.  https://doi.org/10.1002/pd.2642 CrossRefPubMedGoogle Scholar
  9. 9.
    Salomon LJ, Alfirevic Z, Bilardo CM et al (2013) ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 41:102–113.  https://doi.org/10.1002/uog.12342 CrossRefPubMedGoogle Scholar
  10. 10.
    Akolekar R, Syngelaki A, Sarquis R et al (2011) Prediction of early, intermediate and late pre-eclampsia from maternal factors, biophysical and biochemical markers at 11–13 weeks. Prenat Diagn 31:66–74.  https://doi.org/10.1002/pd.2660 CrossRefPubMedGoogle Scholar
  11. 11.
    Bindra R, Curcio P, Cicero S et al (2001) Uterine artery Doppler at 11–14 weeks of gestation in chromosomally abnormal fetuses. Ultrasound Obstet Gynecol 18:587–589.  https://doi.org/10.1046/j.0960-7692.2001.00585.x CrossRefPubMedGoogle Scholar
  12. 12.
    Plasencia W, Maiz N, Bonino S et al (2007) Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 30:742–749.  https://doi.org/10.1002/uog.5157 CrossRefPubMedGoogle Scholar
  13. 13.
    Herraiz I, López-Jiménez EA, García-Burguillo A et al (2009) Role of uterine artery Doppler in interpreting low PAPP-A values in first-trimester screening for Down syndrome in pregnancies at high risk of impaired placentation. Ultrasound Obstet Gynecol 33:518–523.  https://doi.org/10.1002/uog.6366 CrossRefPubMedGoogle Scholar
  14. 14.
    Gallo DM, Wright D, Casanova C et al (2016) Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 19–24 weeks' gestation. Am J Obstet Gynecol 214:619.e1–619.e17.  https://doi.org/10.1016/j.ajog.2015.11.016 CrossRefGoogle Scholar
  15. 15.
    Rolnik DL, Wright D, Poon LC et al (2017) Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 377:613–622.  https://doi.org/10.1056/NEJMoa1704559 CrossRefPubMedGoogle Scholar
  16. 16.
    Velauthar L, Plana MN, Kalidindi M et al (2014) First-trimester uterine artery Doppler and adverse pregnancy outcome: a meta-analysis involving 55 974 women. Ultrasound Obstet Gynecol 43:500–507.  https://doi.org/10.1002/uog.13275 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyUniversity of TuebingenTübingenGermany
  2. 2.Fetal Medicine Foundation USADaytonUSA
  3. 3.Division of Maternal Fetal MedicineWright State UniversityDaytonUSA

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