Sarcouncil Journal of Medical Series

Abstract: Preeclampsia (PE) and fetal growth restriction (FGR) are significant causes of maternal and perinatal morbidity, and effective preventive measures are required to identify them early. Uterine artery Doppler (UtA) monitoring in the late first trimester has turned out to be a possible screening method, with high pulsatility index (PI) and diastolic notching being the two important sonographic findings. The objectives of the study were to determine the predictive ability of uterine artery Doppler, namely, mean UtA-PI and bilateral diastolic notching, at 11-14 gestation weeks, of end result preeclampsia and fetal growth limitation. The study was a cross-sectional study that involved 111 singleton pregnancies in Basrah, Iraq, hospitals from May 2024 to May 2025. At 1114 weeks, a UtA Doppler was done to measure the mean UtA-PI and determine bilateral notching. Outcomes of pregnancy were also noted, such as PE (stratified as early-onset <34 weeks, and late-onset ≥34 weeks), FGR (birth weight below the 10th centile), and normotensive appropriate-for-gestational-age (AGA) delivery. Analysis of predictive performance of elevated UtA-PI (>95th percentile) and bilateral notching was done in terms of sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios. The average UtA-PI was strongly increased in the adverse outcome pregnancies (PE: 1.65 and FGR alone: 1.32) as opposed to normal AGA controls (0.95 and all: p<0.001). To predict any adverse outcome (PE or FGR, n=21), elevated UtA-PI was sensitive (57.1), specific (94.4), PPV (70.6), and LR+ (10.3). The sensitivity of bilateral notching was 52.4% and the specificity was 91.1%. Early-onset PE showed the highest performance, UtA-PI >95th percentile had 100% sensitivity and LR+ of 13.3. The presence of uterine artery Doppler evaluation in 1114 weeks of gestation, and especially a high mean UtA-PI (>95th percentile), is a strong and independent predictor of future preeclampsia and fetal growth restriction with a high specificity and a significantly enhanced likelihood of disease. The method is most effective when used in predicting severe and early-onset phenotypes. The addition of UtA Doppler to the screening protocols in the first trimester could be used to improve early case identification of high-risk pregnancy to be targeted and the implementation of preventive measures.