Low maternal middle cerebral artery Doppler resistance indices can predict future development of pre-eclampsia

Ultrasound Obstet Gynecol. 2012 Oct;40(4):406-11. doi: 10.1002/uog.11078.


Objective: To determine if decreased resistance (vasodilatation) in the maternal middle cerebral artery (MCA) in the second trimester can predict third-trimester development of pre-eclampsia.

Methods: Four-hundred and five low-risk gravidas had MCA transcranial Doppler (TCD) once in the second trimester. Maternal/neonatal outcomes were evaluated after delivery. Mean blood pressure, MCA velocities, resistance index (RI), pulsatility index (PI) and cerebral perfusion pressure (CPP) were compared between normotensive and pre-eclamptic cohorts.

Results: Seven subjects (1.7%) developed pre-eclampsia. An RI of < 0.54 and a PI of < 0.81 were clinically useful in predicting subsequent pre-eclampsia. Areas under the receiver-operating characteristics curves for RI and PI were 0.93 and 0.93, respectively, with optimal sensitivity and specificity of 86% and 93% for both variables. Positive and negative likelihood ratios were 11.8/0.15 (RI) and 12.3/0.15 (PI).

Conclusion: TCD indices of low maternal MCA resistance in the second trimester are predictive of the subsequent development of pre-eclampsia in a low-risk, ethnically homogeneous population.

MeSH terms

  • Adult
  • Blood Flow Velocity
  • Blood Pressure
  • Female
  • Humans
  • Infant, Newborn
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / physiopathology*
  • Pre-Eclampsia / diagnostic imaging
  • Pre-Eclampsia / physiopathology*
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy Trimester, Second*
  • ROC Curve
  • Sensitivity and Specificity
  • Ultrasonography, Doppler, Color*
  • Ultrasonography, Prenatal
  • Vascular Resistance*
  • Vasodilation