Shadows Before Birth: Early Detection of Placental Insufficiency Using First-Trimester Doppler Indices

Abstract

Background:
Placental insufficiency is a major cause of fetal growth restriction (FGR) and adverse perinatal outcomes. Early detection could enable timely interventions to improve fetal survival.

Objective:
To evaluate the predictive accuracy of uterine artery Doppler pulsatility index (PI) in the first trimester for detecting placental insufficiency and subsequent FGR.

Methods:
A prospective cohort study was conducted across three tertiary maternity centers in Italy from January 2022 to December 2023. A total of 612 pregnant women (11–14 weeks gestation) underwent uterine artery Doppler ultrasound. Outcomes measured included FGR (<10th percentile) and abnormal placental histology. PI thresholds were analyzed for predictive performance.

Results:
Placental insufficiency was diagnosed in 12.7% of pregnancies. A uterine artery PI >1.6 showed an AUC of 0.87 (95% CI: 0.83–0.90), sensitivity of 82.4%, and specificity of 81.1% for predicting FGR. Combination with maternal serum PAPP-A improved AUC to 0.91. Women with abnormal Doppler and low PAPP-A had a 5.3-fold increased risk of adverse perinatal outcomes.

Conclusion:
First-trimester uterine artery Doppler, especially when combined with biochemical markers, is a strong predictor of placental insufficiency and FGR. Incorporating this into routine screening could allow earlier risk stratification.