First trimester screening of Hypertensive Disorders of Pregnancy: role of uterine arteries Doppler

Objective. Nowadays preeclampsia first trimester screening is not able to predict the different phenotypes of HDP, that are characterized by different times of onset, fetal growth and patterns of uterine arteries (UtA) Doppler velocimetry.
UtA Doppler velocimetry represents a proxy of placental function and provides indirect information regarding placentation process.
We investigated if, in patients at high risk for HDP according to the Fetal Medicine Foundation (FMF) algorithm, the presence of UtA-PI > 95^th percentile represents a risk factor for adverse maternal and fetal outcomes.
Materials and Methods. Multicentric retrospective study on 244 patients with high risk FMF preeclampsia screening enrolled at “Piero Palagi” Hospital, Florence and at Careggi University Hospital, Florence.
Patients were divided into two groups: UtA-PI ≤ 95^th percentile and UtA-PI > 95^th percentile.
Maternal characteristics, maternal and fetal outcomes were compared.
Results. UtA-PI > 95^th percentile is significantly associated with Fetal Growth Restriction, severe PE and HELLP syndrome and resulted as a possible risk factor for Apgar index ≤ 7 at 1^st minute.
Moreover, smoke habit has been found to be a risk factor, while advanced maternal age, the use of assisted reproductive technology and chronic hypertension unexpectedly resulted protective factors.
Pre-pregnancy BMI resulted irrelevant.
Conclusions. Our study demonstrates that, in patients at high risk for HDP, UtA-PI > 95^th percentile is associated with worse maternal and fetal outcomes. These data should guide clinicians in the management of pregnancy, suggesting a more intensive clinical and ultrasonographic follow-up in order to identify the onset of complications early on and to optimize therapeutic strategies.