First Trimester Uterine Artery Doppler US For Prediction Of Pre-Eclampsia In Individuals At Risk In Erbil Maternity Teaching Hospital

Abstract

Background:
Pre-eclampsia remains a leading cause of maternal and perinatal morbidity and mortality worldwide. Because the pathological processes underlying pre-eclampsia begin early in pregnancy, first-trimester uterine artery Doppler ultrasonography has been proposed as a noninvasive tool for early risk prediction, particularly in high-risk populations.

Objective:
To evaluate the effectiveness and diagnostic performance of first-trimester uterine artery Doppler ultrasonography in predicting the development of pre-eclampsia among pregnant women at high risk.

Methods:
This prospective observational study was conducted at Erbil Maternity Teaching Hospital between January and October 2025. Fifty pregnant women with established risk factors for pre-eclampsia underwent uterine artery Doppler ultrasonography at 11–14 weeks of gestation. The mean uterine artery pulsatility index (PI) and the presence of early bilateral deep diastolic notching were assessed. Participants were followed until delivery to determine the occurrence of pre-eclampsia. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis, and predictors were examined using multivariable logistic regression analysis.

Results:
Pre-eclampsia developed in 10 (20%) of the participants. The first-trimester mean uterine artery PI demonstrated moderate predictive accuracy for pre-eclampsia (AUC = 0.774; 95% CI: 0.644–0.903; p = 0.008). A PI cut-off value of ≥2.55 yielded a sensitivity of 70% and a specificity of 70%. Early bilateral deep diastolic notching in uterine artery was significantly associated with the development of pre-eclampsia (OR = 16.7; 95% CI: 1.9–145.8; p = 0.003) and remained an independent predictor after adjustment (adjusted OR = 11.37; 95% CI: 1.15–112.14; p = 0.037).

Conclusion:
First-trimester uterine artery Doppler ultrasonography shows moderate accuracy in predicting pre-eclampsia among high-risk pregnancies, with early bilateral deep diastolic notching in uterine artery providing strong independent prognostic value. As a readily available and cost-effective screening modality, uterine artery Doppler assessment may support early risk stratification and targeted antenatal surveillance, particularly in resource-limited settings.