Clinical utility of 3D power doppler ultrasound and maternal biomarkers in the prediction of pre-eclampsia in high-risk pregnancies

Approximately 2% of all pregnant women develop pre-eclampsia; women with high-risk co-morbidities are particularly at risk with reported incidences of up to 20%. Evolving evidence suggests that an integrated screening tool combining medical history, ultrasound parameters and serum biomarkers may be of use in defining the patient-specific risk for pre-eclampsia.<br><br>Against this background, this thesis examines the ability of baseline maternal characteristics, placental vascularisation indices, uterine artery Doppler and maternal serum biomarkers (Pregnancy Associated Plasma Protein-A (PAPP-A), Placental like Growth Factor (PlGF), soluble Fms-like tyrosine kinase (sFLt-1) and soluble Endoglin (sEng)) measured in the first and second trimesters of pregnancy to predict pre-eclampsia in high-risk women.<br><br>To determine the added clinical utility and predictive value of these biophysical and biochemical parameters, a prospective longitudinal observational study of high-risk women and low-risk control participants was carried out (PREDICT).

Set within the context of a systematic review evaluating the ability of (first trimester) placental vascularisation indices to predict pre-eclampsia, findings from the PREDICT study demonstrate that placental vascularisation indices perform well for prediction of pre-eclampsia in the first trimester and that measurements are repeatable and reproducible within a high-risk cohort. The added clinical utility of uterine artery Doppler ultrasound for prediction of pre-eclampsia in high-risk women was not apparent, however the additional clinical utility of a number of first (sFlt-1, sFlt-1:PlGF) and second trimester biomarkers (PlGF:sEng) was demonstrated.