Accuracy of First Trimester Uterine Artery Doppler in Early Prediction of Preeclampsia in High-Risk Women

Abstract

Preeclampsia is a complex hypertensive disorder of pregnancy and one of the leading causes of maternal and perinatal morbidity and mortality globally. Its pathophysiology is rooted in defective placentation and abnormal spiral artery remodeling, resulting in impaired uteroplacental perfusion, hypoxia, and the release of anti-angiogenic factors that trigger maternal endothelial dysfunction. Early and accurate prediction of preeclampsia has become a priority in modern obstetric care, as it allows targeted prophylactic measures such as low-dose aspirin, enhanced maternal surveillance, and optimized timing of delivery. Uterine artery Doppler assessment has emerged as a non-invasive and reproducible tool to evaluate uteroplacental blood flow. First-trimester Doppler parameters—including pulsatility index (PI), resistance index (RI), and early diastolic notching—provide valuable insights into abnormal vascular adaptation. When integrated with maternal characteristics, mean arterial pressure, and biochemical markers such as placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A), predictive accuracy improves significantly, particularly for early-onset disease. Despite its limitations related to population variability, technical challenges, and resource constraints, uterine artery Doppler represents a cornerstone of multiparametric screening strategies for preeclampsia and continues to evolve with the integration of advanced imaging and artificial intelligence approaches.