First- and Second-Trimester Uterine Artery Doppler and Hypertensive Disorders in Twin Pregnancies

TL;DR

This study shows that measuring blood flow in the uterine arteries during twin pregnancies can help predict preeclampsia and other complications.

Contribution

The study introduces a two-timepoint uterine artery pulsatility index screening method for improved prediction of preeclampsia in twin pregnancies.

Findings

A mean UTPI above 1.682 in early pregnancy increases preeclampsia risk by 1.5 times.

Combining UTPI measurements at two gestational periods improves prediction of early preeclampsia.

Higher UTPI values at both timepoints are significantly linked to preeclampsia and adverse outcomes.

Abstract

Objective: The objective of this study is the investigation of uterine artery Doppler studies in twin pregnancies. Methods: This retrospective cohort study included 554 twin pregnancies. All women underwent measurement using the mean uterine artery pulsatility index (UTPI) in gestational weeks 11+0–13+6 and 19+0–22+6 for risk assessment regarding the occurrence of preeclampsia and adverse obstetric outcomes. Results: Out of the 554 included women, a total of 51 women (9.2%) developed preeclampsia: 12 women (2.2%) developed early preeclampsia and 39 patients (7.0%) developed late preeclampsia. Adverse pregnancy outcomes occurred in 147 women (26.5%). The optimum cut-off for the mean UTPI to predict preeclampsia was calculated for gestational weeks 11+0–13+6 (UTPI > 1.682) and 19+0–22+6 (UTPI > 1.187). Between gestational weeks 11+0 and 13+6, the risk of developing preeclampsia was approximately 1.5 times higher when the mean UTPI was above the established cut-off. The risk of early preeclampsia increased 2.5-fold, and that of adverse pregnancy outcomes increased 1.5-fold. At 19+0 to 22+6 weeks, the preeclampsia risk doubled when the mean UTPI exceeded the cut-off. The risk increased 4-fold for early preeclampsia and 1.5-fold for adverse pregnancy outcomes. Regression analyses revealed that a mean UTPI above the set cut-off at both time points was significantly associated with preeclampsia, early preeclampsia, and adverse pregnancy outcomes. Conclusions: The best prediction for early preeclampsia can be achieved using a two-tailed screening approach that combines mean UTPI measurements taken at gestational weeks 11+0–13+6 and 19+0–22+6.

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