What are the guidelines on the use of ultrasonography in the diagnosis of preeclampsia?

Updated: Nov 29, 2018
  • Author: Kee-Hak Lim, MD; Chief Editor: Ronald M Ramus, MD  more...
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Answer

Answer

Guidelines on preeclampsia ultrasound were released by the International Society of Ultrasound in Obstetrics and Gynecology on October 15, 2018. [114]

  • The pulsatility index (PI) should be used for examination of uterine artery resistance in the context of preeclampsia (PE) screening.
  • Doppler examination of the uterine arteries at 11 + 0 to 13 + 6 weeks can be performed either transabdominally or transvaginally, according to local preferences and resources.
  • Because maternal factors can affect uterine artery PI, inclusion of uterine artery PI in a multifactorial screening model should be preferred over its use as a standalone test with absolute cut‐offs, whenever feasible.
  • Mean uterine artery PI should be the Doppler index of choice for first-trimester screening.
  • Doppler examination of the uterine arteries at the second‐trimester scan can be performed either transabdominally or transvaginally.
  • Mean uterine artery PI should be used for prediction of PE. In the case of a unilateral placenta, a unilaterally increased PI does not appear to increase the risk for PE if the mean PI is within normal limits.
  • Although uterine artery velocimetry can be assessed transvaginally, the most common method of uterine artery Doppler examination in the third trimester is a transabdominal approach.
  • The most efficient screening model for identification of women at risk of PE seems to be a combination of maternal factors, maternal mean arterial blood pressure, uterine artery Doppler, and placental growth factor (PlGF) level at 11-13 weeks.
  • There is convincing evidence that low‐dose aspirin can significantly decrease the risk of early PE when begun at first‐trimester screening.

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