Uterine arteries pulsatility index by Doppler ultrasound in the prediction of preeclampsia: an updated systematic review and meta-analysis

• Published in: Archives of gynecology and obstetrics Vol. 309; no. 2; pp. 427 - 437
• Main Authors: Liu, Yan, Xie, Zilu, Huang, Yong, Lu, Xin, Yin, Fengling
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2024; Springer Nature B.V
• Subjects: Endocrinology; Female; Gestational age; Gynecology; Human Genetics; Humans; Infant, Newborn; Medicine; Medicine & Public Health; Obstetrics/Perinatology/Midwifery; Pre-Eclampsia - diagnostic imaging; Preeclampsia; Pregnancy; Review; Sensitivity and Specificity; Systematic review; Ultrasonic imaging; Ultrasonography, Doppler; Ultrasonography, Prenatal; Uterine Artery - diagnostic imaging; Sensitivity; Specificity; Timing; Preeclampsia; Pulsatility index; Meta-analysis
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-023-07044-2

Background Preeclampsia is a common pregnancy complication with serious potential risks for maternal and neonatal health. Early prediction of preeclampsia is crucial for timely prevention, surveillance, and treatment to improve maternal and neonatal outcomes. This systematic review aimed to summarize the available evidence on the prediction of preeclampsia based on Doppler ultrasound of uterine arteries at different gestational ages. Methods A systematic literature search and meta-analysis were conducted to evaluate the sensitivity and specificity of the pulsatility index of Doppler ultrasound of uterine arteries for predicting preeclampsia. The timing of ultrasound scans within and beyond 20 weeks of gestational age was compared to assess its effect on the sensitivity and specificity of the pulsatility index. Results This meta-analysis included 27 studies and 81,673 subjects (3309 preeclampsia patients and 78,364 controls). The pulsatility index had moderate sensitivity (0.586) and high specificity for predicting preeclampsia (0.879) (summary point: sensitivity 0.59; 1-specificity 0.12). Subgroup analysis revealed that ultrasound scans performed within 20 weeks of gestational age did not significantly affect the sensitivity and specificity for predicting preeclampsia. The summary receiver operator characteristic curve showed the pulsatility index’s optimal range of sensitivity and specificity. Conclusions The uterine arteries pulsatility index measured by Doppler ultrasound is useful and effective for predicting preeclampsia and should be implemented in the clinical practice. The timing of ultrasound scans at different gestational age ranges does not significantly affect the sensitivity and specificity.