Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.
Ultrasound Obstet Gynecol. 2021 Apr;57(4):600-606. doi: 10.1002/uog.23517. Epub 2021 Mar 15.
To examine the potential value of maternal ophthalmic artery Doppler at 35-37 weeks' gestation in combination with the established biomarkers of pre-eclampsia (PE), including mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1), in the prediction of subsequent development of PE.
This was a prospective observational study in women attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ultrasound examination for fetal anatomy and growth, assessment of flow velocity waveforms from the maternal ophthalmic arteries, and measurement of MAP, UtA-PI, serum PlGF and serum sFlt-1. The competing-risks model was used to estimate the individual patient-specific risks of delivery with PE at any time and at < 3 weeks after assessment by a combination of maternal demographic characteristics and medical history with biomarkers. The area under the receiver-operating-characteristics curve and detection rate (DR) of delivery with PE, at a 10% false-positive rate (FPR), in screening by combinations of maternal factors with ophthalmic artery second to first peak of systolic velocity ratio (PSV ratio), MAP, UtA-PI, serum PlGF and serum sFlt-1 were determined. The modeled performance of screening for PE was also estimated.
The study population of 2287 pregnancies contained 60 (2.6%) that developed PE, including 19 (0.8%) that delivered with PE at < 3 weeks after assessment. The PSV ratio improved the prediction of PE with delivery at any stage after assessment provided by maternal factors alone (from 25.4% to 50.6%), maternal factors and MAP (54.3% to 62.7%), maternal factors, MAP and PlGF (68.3% to 70.8%) and maternal factors, MAP, PlGF and sFlt-1 (75.7% to 76.7%), at a FPR of 10%. The PSV ratio also improved the prediction of PE with delivery at < 3 weeks after assessment provided by maternal factors alone (from 31.0% to 69.4%), maternal factors and MAP (74.1% to 83.4%), maternal factors, MAP and UtA-PI (77.1% to 85.0%) and maternal factors, MAP and PlGF (84.8% to 88.6%). The empirical results for DR at a 10% FPR were consistent with the modeled results. Screening by a combination of maternal factors with MAP and PSV ratio also detected 59.4% (95% CI, 58.6-82.5%) of cases of gestational hypertension with delivery at any stage after assessment, and 86.7% (95% CI, 82.4-100%) of those with delivery at < 3 weeks after assessment.
Ophthalmic artery Doppler could potentially improve the performance of screening for PE at 35-37 weeks, especially imminent PE with delivery within 3 weeks after assessment, but further studies are needed to validate this finding. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
探讨孕 35-37 周时的母体眼动脉多普勒与子痫前期（PE）的既定生物标志物（包括平均动脉压（MAP）、子宫动脉搏动指数（UtA-PI）、胎盘生长因子（PlGF）和可溶性 fms 样酪氨酸激酶-1（sFlt-1））联合使用，预测随后发生 PE 的潜在价值。
这是一项在孕 35+0 至 36+6 周时常规医院就诊的妇女中进行的前瞻性观察性研究。此次就诊包括记录产妇的人口统计学特征和病史、胎儿解剖和生长的超声检查、评估母体眼动脉的血流速度波形，以及测量 MAP、UtA-PI、血清 PlGF 和血清 sFlt-1。使用竞争风险模型估计通过母体特征和生物标志物组合在任何时候以及在评估后<3 周内分娩的 PE 的个体患者风险。确定了在 10%假阳性率（FPR）下，通过母体因素与眼动脉收缩期速度比（PSV 比）、MAP、UtA-PI、血清 PlGF 和血清 sFlt-1的组合进行筛查时，PE 分娩的接受者操作特征曲线下面积（AUC）和检出率（DR）。还估计了 PE 筛查的模型性能。
在 2287 例妊娠中，有 60 例（2.6%）发生了 PE，其中 19 例（0.8%）在评估后<3 周内分娩。PSV 比可改善由母体因素单独提供的评估后任何阶段 PE 的预测（从 25.4%提高到 50.6%）、母体因素和 MAP（从 54.3%提高到 62.7%）、母体因素、MAP 和 PlGF（从 68.3%提高到 70.8%）和母体因素、MAP、PlGF 和 sFlt-1（从 75.7%提高到 76.7%），在 FPR 为 10%的情况下。PSV 比还可以改善由母体因素单独提供的评估后<3 周内分娩的 PE 的预测（从 31.0%提高到 69.4%）、母体因素和 MAP（从 74.1%提高到 83.4%）、母体因素、MAP 和 UtA-PI（从 77.1%提高到 85.0%）和母体因素、MAP 和 PlGF（从 84.8%提高到 88.6%）。在 10%FPR 时的 DR 的经验结果与模型结果一致。通过 MAP 和 PSV 比的母体因素组合进行筛查，还可以检测到 59.4%（95%CI，58.6-82.5%）的评估后任何阶段分娩的妊娠期高血压病例，以及 86.7%（95%CI，82.4-100%）的评估后<3 周内分娩的病例。
眼动脉多普勒可能有助于提高 35-37 周时 PE 筛查的性能，特别是评估后 3 周内分娩的即刻 PE，但需要进一步研究来验证这一发现。©2020 年国际妇产科超声学会。
