Page 1 of 14
British Journal of Healthcare and Medical Research - Vol. 12, No. 02
Publication Date: April 25, 2025
DOI:10.14738/bjhmr.1202.18491.
Oforma, N. H., Emmanuel, O. O., Isoken, A., Xavier, E., Governor, O., Festus, O., Anthonia, N., Joseph, E., & Theophilus, A. (2025).
Prediction of Preeclampsia and Other Adverse Pregnancy Outcomes in Women of Advanced Maternal Age: The Use of Mid Trimester
Uterine Artery Doppler Velocimetry. British Journal of Healthcare and Medical Research, Vol - 12(02). 120-133.
Services for Science and Education – United Kingdom
Prediction of Preeclampsia and Other Adverse Pregnancy
Outcomes in Women of Advanced Maternal Age: The Use of Mid
Trimester Uterine Artery Doppler Velocimetry
Ngwu Hillary Oforma
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Olugbenga Olorungbogo Emmanuel
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Aikpopo Isoken
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Enodiana Xavier
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Okome Governor
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Omorogbe Festus
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Njoku Anthonia
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Eigbefoh Joseph
Department of Obstetrics and Gynaecology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Akhigbe Theophilus
Department of Radiology,
Irrua Specialist Teaching Hospital Irrua, Edo State, Nigeria
Page 2 of 14
121
Oforma, N. H., Emmanuel, O. O., Isoken, A., Xavier, E., Governor, O., Festus, O., Anthonia, N., Joseph, E., & Theophilus, A. (2025). Prediction of
Preeclampsia and Other Adverse Pregnancy Outcomes in Women of Advanced Maternal Age: The Use of Mid Trimester Uterine Artery Doppler
Velocimetry. British Journal of Healthcare and Medical Research, Vol - 12(02). 120-133.
URL: http://dx.doi.org/10.14738/bjhmr.1202.18491.
ABSTRACT
Background: Adverse pregnancy outcomes such as pre-eclampsia, gestational
diabetes, and low birth weight are significant contributors to maternal and fetal
morbidity. The use of Doppler ultrasonography, particularly pulsatility index (PI)
and the presence of a notch, has been explored as a predictive tool for identifying
pregnancies at risk of these complications. Objectives: This study aimed to evaluate
the association between uterine artery Doppler findings, specifically PI and
notching, with adverse maternal and fetal outcomes among pregnant women.
Methodology: A cross-sectional study was conducted among 141 pregnant women
at Irrua Specialist Teaching Hospital, Nigeria. Doppler ultrasonography was used to
assess PI and the presence of a notch. Participants were followed up to delivery, and
data on outcomes, including pre-eclampsia, gestational diabetes, low birth weight,
and pre-term delivery, were analyzed. Statistical analysis was performed using
SPSS 23.0, with significance set at p < 0.05. Results: Women with abnormal PI were
four times more likely to develop pre-eclampsia compared to those with normal PI.
Abnormal PI was also associated with twice the risk of gestational diabetes and
three times the likelihood of delivering a low-birth-weight infant. The presence of a
notch was significantly associated with pre-eclampsia, doubling the risk compared
to cases without a notch. However, neither abnormal PI nor notching demonstrated
significant associations with caesarean section rates, ICU admission, or poor APGAR
scores. Conclusion: Doppler findings, particularly abnormal PI and notching, are
valuable in identifying pregnancies at risk for complications like pre-eclampsia and
low birth weight. Routine integration of Doppler screening into antenatal care is
recommended to enable early detection and timely interventions, thereby
improving maternal and fetal outcomes.
Keywords: Doppler Ultrasonography, Preeclampsia, Pregnancy Outcomes Pulsatility
Index, Uterine Artery.
BACKGROUND
Adverse maternal outcomes during pregnancy are a significant global concern, particularly in
women of advanced maternal age (AMA), typically defined as 35 years or older1. AMA increases
the risk of complications such as hypertensive disorders, gestational diabetes, preterm birth,
and fetal growth restriction (FGR), often due to impaired placentation and reduced uterine
blood flow, which lead to placental insufficiency, negatively impacting maternal and fetal
health2,3.
Preeclampsia, a hypertensive disorder that occurs after the 20th week of gestation, is one of the
leading causes of maternal and fetal morbidity and mortality worldwide4. It affects 5% to 7%
of pregnancies globally and contributes to over 70,000 maternal deaths and approximately
500,000 fetal deaths annually5,6.
In the United States, Black women are particularly vulnerable, experiencing up to70% higher
incidence of preeclampsia compared to White women, with more severe outcomes such as
kidney damage and increased maternal mortality7,8. Risk factors for preeclampsia include first
pregnancies, hypertension, chronic kidney disease, diabetes, obesity (BMI ≥ 35 kg/m2), history
of preeclampsia, and age > 40 years9,10.
Page 3 of 14
122
British Journal of Healthcare and Medical Research (BJHMR) Vol 12, Issue 02, April-2025
Services for Science and Education – United Kingdom
In sub-Saharan Africa, including Nigeria, preeclampsia and other adverse pregnancy outcomes
are prevalent, with a pooled incidence of 13% in the region11. In Nigeria, the maternal mortality
rate associated with preeclampsia is high at 6.04%, while fetal mortality stands at 16.73%12,13.
Limited access to healthcare, inadequate antenatal care, and lack of early screening contribute
to delayed diagnoses and poor outcomes14.
Women of AMA are also at increased risk of gestational diabetes (GDM) with women over 40
years having almost two-fold risk of developing GDM15,16. GDM is associated with complications
such as macrosomia, preterm birth, and cesarean delivery17. Additionally, AMA increases the
risk of placenta previa, placental abruption, and preterm birth, all of which heighten the risk of
maternal hemorrhage and severe fetal morbidity18,19. Fetal growth restriction is also more
common in pregnancies complicated by preeclampsia and AMA, due to inadequate placental
blood supply20,21.
In Nigeria and other sub-Saharan African countries, addressing the risks of AMA is key. Non- invasive methods like uterine artery Doppler velocimetry have shown promise in identifying
pregnancies at high risk of adverse outcomes, including preeclampsia, FGR, and preterm
birth22,23. Uterine artery Doppler measures blood flow in the uterine arteries using ultrasound
and can detect impaired placental perfusion, an early indicator of preeclampsia and FGR24.
Research has shown that uterine artery Doppler velocimetry significantly improves the
prediction of preeclampsia. The presence of a diastolic notch and an elevated resistance index
(RI) in the uterine arteries can indicate a higher risk of adverse outcomes, as considering both
the diastolic notch and an RI > 0.65 increases the detection rate for preeclampsia by up to
87.51%25,26. Additionally, uterine artery Doppler, when combined with other markers, can
detect up to 75% of preterm preeclampsia cases.27 Early detection through Doppler allows for
timely interventions such as closer monitoring, prophylactic treatment, and, when necessary,
early delivery to reduce risks for both mother and fetus28.
The non-invasive nature of Doppler ultrasound makes it particularly valuable in resource- limited settings like Nigeria, where access to more invasive diagnostic methods may be limited.
As a cost-effective and accessible screening tool, uterine artery Doppler velocimetry plays a
crucial role in identifying high-risk pregnancies, improving maternal and fetal health outcomes
by enabling better management of preeclampsia and gestational diabetes.
METHODOLOGY
Study Area
The study was conducted at the Obstetrics and Gynaecology Department of Irrua Specialist
Teaching Hospital (ISTH), located in Irrua, the local government headquarters of Esan Central
Local Government Area in Edo State, Nigeria. Established in 1991, the hospital served as a major
referral center for two of the three senatorial districts of Edo State (Edo Central and Edo North),
as well as for neighboring states, including Delta, Ondo, and Kogi. ISTH provided a wide range
of maternal and child health services, including antenatal care and delivery, and had an average
annual delivery rate of 1800. The Obstetrics and Gynaecology Department was equipped with
48 obstetric beds and 42 gynecological beds. Antenatal clinics were held three times a week,
where ultrasound equipment with Doppler capabilities was routinely used, and this equipment
played a key role in the study.