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Ophthalmic artery Doppler predictive of pre-eclampsia

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Dr. Anita Kant, Chairman & Head Department of Gynae & Obstetrics, Asian Institute of Medical Sciences, Faridabad    19 December 2022

Ophthalmic artery Doppler indices can predict development of preeclampsia in pregnant women at 28-32 weeks of gestation, suggests a study to be published in the January 2023 issue of The International Journal of Gynecology & Obstetrics.1

 

Women at 28-32 weeks of gestation with normal blood pressure underwent uterine and ophthalmic artery Doppler ultrasound to examine if ophthalmic artery Doppler could additionally be potentially predictive of preeclampsia in the third trimester of pregnancy. Pregnancy-associated plasma protein A (PAPP-A) values in the first trimester were obtained in addition to maternal and fetal status.

 

Forty-eight women out of the 795 women included in the study developed preeclampsia during the third trimester. Various ophthalmic Doppler indices such as first and second peak systolic velocities (PSVs), second to first peak ratio (PR) and pulsatility index (PI) were found to be significantly different in women who subsequently developed preeclampsia. “The average PR (sensitivity: 100%; specificity: 90%) and PI between the eyes, PAPP-A multiple of median and uterine artery PI were determined to be the most important predictors of PE, which were subsequently integrated into a multiple regression model (sensitivity: 94%; specificity: 93%).”Factors associated with increased risk of pre-eclampsia were mean uterine artery pulsatility index (UtA PI) with OR of 18.60, right and left second PSVs (OR 1.11), right PR × 100 (OR 1.15), left PR × 100 (OR 1.16) and average of PR × 100 between the eyes (OR 1.18).

 

Evidence has shown reduced impedance to flow and an increase in flow velocity in the ophthalmic arteries in pregnant women with pre-eclampsia vs women with normal pregnancies. The ratio of the second to the first peak of systolic velocity has been reported to be the most useful of ophthalmic Doppler parameters.2 This ratio is increased in women who developed pre-eclampsia.In this study too, PR showed the highest sensitivity, specificity, positive predictive value (PPV), negative predictive value (PPV) at a 10% false-positive rate.

 

Ophthalmic artery Doppler therefore can be a useful tool to screen women at greater risk of preeclampsia in the third trimester of pregnancy. Identification of at-risk women enables timely initiation of preventive measures and prevent development of preeclampsia

 

References

 

  1. Maasoumeh Saleh, et al. Diagnostic value of ophthalmic artery Doppler indices for prediction of preeclampsia at 28-32 weeks of gestation. Int J Gynaecol Obstet. 2023 Jan;160(1):120-130. doi: 10.1002/ijgo.14305. Epub 2022 Jul 6.
  2. Sarno M, et al. Ophthalmic artery Doppler in prediction of pre-eclampsia at 35-37 weeks gestation. Ultrasound Obstet Gynecol. 2020 Nov;56(5):717-72.
  3. Nicolaides KH, et al. Ophthalmic artery Doppler in the prediction of preeclampsia. Am J Obstet Gynecol. 2022 Feb;226(2S):S1098-S1101.

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