First Trimester Prediction of Preeclampsia Based on Maternal Factors, Biomarkers and 3D Power Doppler of Placental Bed Vascularization

Preeclampsia (PE) complicates 2-8% of pregnancies. Being a multisystem disorder, it is the leading cause of maternal and perinatal morbidity and mortality worldwide [1, 2]. The etiology of PE remains unclear, but it is recognized that impaired growth and development of placental villi and accompanying this process vascularization play an important role in the pathogenesis of the disease [3]. PE is characterized by deteriorated physiological transformation of uterine spiral arteries and chronic utero-placental hypoperfusion [4]. PE can be represented by two main phenotypes with early and late manifestation of the disease. Early placental insufficiency is mainly associated with early PE [4]. Early detection of women at risk of PE development is a key objective of antenatal care. Significant resources are currently focused on the development and improvement of screening tests of the first trimester, as this approach will allow us to benefit from the start of preventive therapy and improve the quality of monitoring patients [5]. There is a wide range of effectiveness of available prognostic tests and markers, which include maternal risk factors, biophysical and/or biochemical factors alone or combined together. Combination of basic maternal risk with biophysical parameters such as maternal blood pressure (BP) and uterine artery dopplerometry (UtA) allows to achieve an early PE detection rate of 44-80% and 28-40% for late PE with 10% of false-positive result (FPR) rate [6, 7]. Doppler parameters of uterine arteries blood flow, abnormalities of which indirectly reflect the process of inadequate trophoblast invasion in maternal spiral arteries, are combined with biochemical markers, thus leading to better characterization of the process of placentation [8]. Biochemical markers that include PAPP-A, circulating angiogenic factors, such as placental growth factor (PlGF), may improve prognostic algorithms, the detection rate of which in this case varies from 47 to 96% [9, 10]. The search for new biomarkers and their optimal combinations in order to improve the efficiency of PE prediction still continues [8]. Three-dimensional (3D) echography technologies with the ability of visualization of vascular volumes make it possible to directly assess early changes in the utero© A group of authors, 2018