Prins Leah I, Smith Eric, Naaktgeboren Christiana M, Khan Mehdjebien G, Bilardo Caterina M, Griffioen Wim, Gordijn Sanne J, Damhuis Stefanie E, Ganzevoort Wessel
Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands.
Ultrasound Center BovenMaas, Rotterdam, the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2025 Jul;311:114058. doi: 10.1016/j.ejogrb.2025.114058. Epub 2025 May 14.
This study aimed to evaluate the inter- and intra-observer reliability of Doppler ultrasound measurements of the uterine artery (UtA) pulsatility index (PI) in the first trimester of pregnancy. Doppler measurement of the UtA is an integral component in algorithms for calculating risks for developing conditions like pre-eclampsia and fetal growth restriction and for deciding which women should be given low-dose aspirin.
This was a prospective observational cross-sectional study, enrolling low-risk singleton pregnant women between 11 + 0 and 13 + 6 weeks of gestation. Two sonographers alternated in performing three sets of transabdominal Doppler measurements of both right and left UtA. The study employed the True Reproducibility of Ultrasound Technique (TRUST) criteria to assess consistency of measurements. Statistical analysis involved calculating intra- and interobserver reliability and the proportion of measurements above the 95th percentile. Sensitivity analyses considered probe type and BMI.
A total of 58 pregnant women were included, resulting in 689 UtA Doppler measurements. Approximately 7.7% of these measurements exceeded the 95th percentile corrected for gestational age. Intra-observer reliability showed poor to moderate intra-class correlation (ICC) values. Interobserver reliability showed poor ICC values for the left and right UtA solely, and a moderate ICC for the average of the left and right UtA taken together. There was moderate to very good agreement between observers for measurements exceeding the 95th percentile. Sensitivity analyses revealed consistent results for probe type, but showed inverse correlation between BMI and the ICC of Doppler measurements.
The study showed at best a moderate reliability of first trimester transabdominal Doppler PI measurements of the uterine artery, according to TRUST criteria, and were negatively influenced by higher BMI. Continued research and innovation combined with regular training programs can enhance the reliability of both uterine Doppler and biochemical markers, ultimately further improving their clinical utility.
本研究旨在评估妊娠早期经腹多普勒超声测量子宫动脉（UtA）搏动指数（PI）时观察者间及观察者内的可靠性。UtA的多普勒测量是计算先兆子痫和胎儿生长受限等疾病发生风险以及决定哪些女性应服用低剂量阿司匹林的算法中的一个重要组成部分。
这是一项前瞻性观察性横断面研究，纳入妊娠11 + 0至13 + 6周的低风险单胎孕妇。两名超声检查人员交替对左右UtA进行三组经腹多普勒测量。该研究采用超声技术的真实再现性（TRUST）标准来评估测量的一致性。统计分析包括计算观察者内和观察者间的可靠性以及高于第95百分位数的测量比例。敏感性分析考虑了探头类型和体重指数（BMI）。
共纳入58名孕妇，进行了689次UtA多普勒测量。这些测量中约7.7%超过了根据孕周校正后的第95百分位数。观察者内可靠性显示组内相关系数（ICC）值为低到中度。观察者间可靠性仅显示左、右UtA的ICC值较低，而左右UtA平均值的ICC为中度。对于超过第95百分位数的测量，观察者之间有中度到非常好的一致性。敏感性分析显示探头类型的结果一致，但BMI与多普勒测量的ICC呈负相关。
根据TRUST标准，该研究显示妊娠早期经腹多普勒测量子宫动脉PI的可靠性充其量为中度，且受较高BMI的负面影响。持续的研究和创新结合定期培训计划可以提高子宫多普勒和生化标志物的可靠性，最终进一步提高它们的临床效用。
