# 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.

## Key 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.