First-Trimester Uterine Artery Doppler as a Predictor of Preeclampsia in High-Risk Pregnancies

Background: Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Early identification of high-risk pregnancies through first-trimester screening may enable timely interventions and improved outcomes. So, we aimed to evaluate the predictive accuracy of first-trimester uterine artery Doppler for prediciting preeclampsia in high-risk pregnant women. Methods: This prospective cohort study was conducted at Zagazig University Hospital from May to November 2023, including 114 high-risk pregnant women at 10-13+6 weeks gestation. Participants underwent transvaginal uterine artery Doppler assessment measuring pulsatility index (PI) and early diastolic notch (EDN). Follow-up was conducted every two weeks to monitor blood pressure and proteinuria development. Preeclampsia was diagnosed according to American College of Obstetricians and Gynecologists criteria. Results: Twenty-six women (22.8%) developed preeclampsia. The mean uterine artery PI was significantly higher in the preeclampsia group compared to controls (2.6 ± 0.43 vs. 1.71 ± 0.49, p < 0.001). Using a PI cutoff of ≥2.03, sensitivity and specificity were 61.54% and 86.23%, respectively. EDN alone showed similar performance (61.54% sensitivity, 84.1% specificity). The combination of elevated PI and EDN demonstrated superior predictive accuracy with 69.23% sensitivity, 93.18% specificity, 75% positive predictive value, and 93% negative predictive value. Conclusion: First-trimester uterine artery Doppler assessment, particularly the combination of elevated PI and EDN, provides valuable predictive information for preeclampsia development in high-risk pregnancies, enabling early identification and appropriate clinical management.