Evaluation of the role of serum markers and Doppler ultrasonography of uterine artery in predicting preeclampsia at the second trimester of pregnancy: A systematic review

Document Type : Review Article

Authors

1 M.Sc. in Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant Professor, Department of Obstetrics and Gynecology, Women Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 PhD in Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

ntroduction: Preeclampsia is the most common medical complication in pregnancy. Regarding the pathophysiology and complex etiology of preeclampsia, a wide range of markers have been investigated. In addition to predictive value, identification of these factors may provide a clear mechanism for the pathogenesis of preeclampsia. This review study was performed with aim to evaluate the role of four serum markers and uterine artery Doppler ultrasonography in predicting preeclampsia at second trimester of pregnancy.
Methods: In this review study, the databases of SID, Weily online library, Elsevier, Scopus, Pubmed, and the Google Scholar search engine were used during 2000 to 2017 in order to find the relevant studies. To access all articles in English and Persian, the key words of BHCG, Inhibin A, Activin A, alpha-fetoprotein, serum markers, uterine artery Doppler sonography, second trimester, and preeclampsia prediction were used with all possible combinations of these words.
Results: The results of various studies indicate that none of the studied markers, including AFP, β-HCG, INH-A and Activin A alone, do not provide predictive power for preeclampsia with high sensitivity and specificity. However, uterine artery Doppler ultrasonography at second trimester of pregnancy can be used as a screening test to predict preeclampsia in high risk women.
Conclusion: The most important strategies for prediction of preeclampsia include individual characteristics, uterine artery ultrasonography, and biomarkers. None of these markers alone can't predict preeclampsia with high sensitivity and specificity.

Keywords


  1. Taghizadeh ZI, Rezaeipour A, Kazemnejad AN, Golboni F. Effect of positive predictive value of serum hematocrit levels on early detection of preeclampsia. J Hayat 2009; 15(2):39-45. (Persian).
  2. Safari M, Yzdan Panah B. Prevalence of pre-eclampsia and its correlated maternal and fetal complications, Emam Sajjad Hospital, Yasuj, 2001. J Shahrekord Univ Med Sci 2003; 5(2):47-53. (Persian).
  3. Cunningham FG, MacDonald PC, Gant NF. Williams’s obstetrics. New York, NY: McGraw-Hill Professional; 2014.
  4. Van Lerberghe W. The World Health Report 2005: make every mother and child count. Geneva: World Health Organization; 2005. P. 41-58.
  5. Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis and management. Vasc Health Risk Manag 2011; 7:467-74.
  6. Kuc S, Wortelboer EJ, van Rijn BB, Franx A, Visser GH, Schielen PC. Evaluation of 7 serum biomarkers and uterine artery Doppler ultrasound for first-trimester prediction of preeclampsia: a systematic review. Obstet Gynecol Surv 2011; 66(4):225-39.
  7. Raymond D, Peterson E. A critical review of early-onset and late-onset preeclampsia. Obstet Gynecol Surv 2011; 66(8):497-506.
  8. Park HJ, Kim SH, Jung YW, Shim S, Kim JY, Cho YK, et al. Screening models using multiple markers for early detection of late-onset preeclampsia in low-risk pregnancy. BMC Pregnancy Childbirth 2014; 14:35.
  9. Huppertz B. Placental origins of preeclampsia: challenging the current hypothesis. Hypertension 2008; 51(4):970-5.
  10. Jones CJ, Fox H. An ultrastructurel and ultrahistochemical study of the human placenta in maternal preeclampsia. Placenta 1980; 1(1):61-76.
  11. Gagnon A, Wilson RD. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 2008; 30(10):918-32.
  12. Spencer K, Yu CK, Cowans NJ, Otigbah C, Nicolaides KH. Prediction of pregnancy complications by first-trimester maternal serum PAPP-A and free beta-hCG and with second-trimester uterine artery Doppler. Prenat Diagn 2005; 25(10):949-53.
  13. Matin S, Moravvejie Asl M, Vaseie M. Correlation between maternal serum level of beta-human chorionic gonadotropin during 16-20 weeks of pregnancy and incidence of preeclampsia. HBI J 2009; 7(3):190-5.
  14. Audibert F, Benchimol Y, Benattar C, Champagne C, Frydman R. Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry. Fetal Diagn Ther 2005; 20(1):48-53.
  15. Olsen RN, Woelkers D, Dunsmoor-Su R, Lacoursiere DY. Abnormal second-trimester serum analytes are more predictive of preterm preeclampsia. Am J Obstet Gynecol 2012; 207(3):228.e1-7.
  16. Roiz‐Hernández J, Cabello‐Martínez JD, Fernández‐Mejía M. Human chorionic gonadotropin levels between 16 and 21 weeks of pregnancy and prediction of pre‐eclampsia. Int J Gynecol Obstet 2006; 92(2):101-5.
  17. Dayal M, Gupta P, Varma M, Ghosh UK, Bhargava A. Role of second trimester maternal serum markers as predictor of preeclampsia. J Obstet Gynecol India 2011; 61(1):38-41.
  18. Shenhav S, Gemer O, Sassoon E, Volodarsky M, Peled R, Segal S. Mid‐trimester triple test levels in early and late onset severe pre‐eclampsia. Prenat Diagn 2002; 22(7):579-82.
  19. Shenhav S, Gemer O, Volodarsky M, Zohav E, Segal SH. Midtrimester triple test levels in women with severe preeclampsia and HELLP syndrome. Acta Obstet Gynecol Scand 2003; 82(10):912-5.
  20. Aquilina J, Maplethorpe R, Ellis P, Harrington K. Correlation between second trimester maternal serum inhibin-A and human chorionic gonadotrophin for the prediction of pre-eclampsia. Placenta 2000; 21(5-6):487-92.
  21. Davidson EJ, Riley SC, Roberts SA, Shearing CH, Groome NP, Martin CW. Maternal serum activin, inhibin, human chorionic gonadotrophin and a-fetoprotein as second trimester predictors of pre-eclampsia. Int J Obstet Gynaecol 2003; 110(1):46-52.
  22. Emine AY, Kavak Z, Elter K, Gokaslan H, Pekin T. Screening for pre-eclampsia by using maternal serum inhibin A, activin A, human chorionic gonadotropin, unconjugated estriol, and alpha-fetoprotein levels and uterine artery Doppler in the second trimester of pregnancy. Aust N Z J Obstet Gynaecol 2005; 45(4):283-8.
  23. Audibert F, Benchimol Y, Benattar C, Champagne C, Frydman R. Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine Doppler velocimetry. Fetal Diagn Ther 2005; 20(1):48-53.
  24. Moghaddami Tabrizi N, Eazadi Mood N, Tahmasbi M. Midtrimester serum B-subunit human chorionic gonadotropin levels and the subsequent development of preeclampsia. Tehran Univ Med J 2001; 59(4):63-6. (Persian).
  25. Florio P, Reis FM, Pezzani I, Luisi S, Severi FM, Petraglia F. The addition of activin A and inhibin A measurement to uterine artery Doppler velocimetry to improve the early prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2003; 21(2):165-9.
  26. Muttukrishna S, North RA, Morris J, Schellenberg JC, Taylor RS, Asselin J, et al. Serum inhibin A and activin A are elevated prior to the onset of preeclampsia. Hum Reprod 2000; 15(7):1640-5.
  27. Grobman WA, Wang EY. Serum levels of activin A and inhibin A and the subsequent development of preeclampsia. Obstet Gynecol 2000; 96(3):390-4.
  28. Bhattacharyya SK, Kundu S, Kabiraj SP. Prediction of preeclampsia by midtrimester uterine artery Doppler velocimetry in high-risk and low-risk women. J Obstet Gynecol India 2012; 62(3):297-300.
  29. Coleman MA, Mccowan LM, North RA. Mid-trimester uterine artery Doppler screening as a predictor of adverse pregnancy outcome in high-risk women. Ultrasound Obstet Gynecol 2000; 15(1):7-12.
  30. Barzin M, Gholami Z, Erfani A, Bahari M, Hashemi H. Determination of prognostic value of ureteral artery sonography for pre-eclampsia in pregnant women. J Mazandaran Univ Med Sci 2015; 25(124):10-8. (Persian).
  31. Sahoo K, Shaha P, Bhairagond SH, Raj V. The role of uterine artery Doppler sonography in predicting pre eclampsia at 14-20 Weeks of Gestation. Int J Sci Res 2016; 5(2):37-46.
  32. Padmalatha VV, Rao PS, Abraham S, Thomas A. Predicting pre-eclampsia & fetal growth restriction through second trimester uterine artery Doppler sonography: an Indian experience. IOSR J Dental Med Sci 2013; 12(1):21-6.
  33. Spencer K, Cowans NJ, Chefetz I, Tal J, Meiri H. First-trimester maternal serum PP-13, PAPP-A and second-trimester uterine artery Doppler pulsatility index as markers of pre-eclampsia. Ultrasound Obstet Gynecol 2007; 29(2):128-34.
  34. Pongrojpaw D, Chanthasenanont A, Nanthakomon T. Second trimester uterine artery Doppler screening in prediction of adverse pregnancy outcome in high risk women. J Med Assoc Thai 2010; 93(Supple 7):S127-30.
  35. Myatt L, Clifton RG, Roberts JM, Spong CY, Hauth JC, Varner MW, et al. The Utility of uterine artery Doppler velocimetry in prediction of preeclampsia in a low-risk population. Obstet Gynecol 2012; 120(4):815-22.
  36. Eslamian L. Elevated maternal serum AFP in second trimester of pregnancy. Iran J Obstet Gynecol Infertil 2012; 7:1-4. (Persian).
  37. Lotfalizadeh M, Khoshsima M. Relationship between maternal age and season with preeclampsia in the patients admitted in gynecology ward of Imam-Reza hospital during 3 years (2001-2004). Iran J Obstet Gynecol Infertil 2016; 19(8):1-5. (Persian).
  38. Layegh P, Afiat M, Farrokh D, Salehi M, Rezvani Mahmouee Z, Mardani R. Evaluation of Uterine artery indexes in Doppler sonography for predicting neonatal outcomes in preeclamptic pregnancies. Iran J Obstet Gynecol Infertil 2016; 19(9):11-6. (Persian).
  39. Lorzadeh N, Samimi S, Birjandi M. Association of fetal gender with maternal serum β-hCG and testosterone in normotensive and preeclamptic pregnancies. Iran J Obstet Gynecol Infertil 2010; 13(1):13-9. (Persian).