EP17.21: Uterine artery Doppler and triple marker positivity for the detection of adverse pregnancy outcome in primary antiphospholipid syndrome

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To compare the diagnostic performance of second trimester mean uterine artery Doppler pulsatility index (ut PI) and triple marker positivity for adverse pregnancy outcome (APO) in women with primary antiphospholipid syndrome (PAPS). Retrospective cohort study of consecutive singleton pregnancies complicated by PAPS (2005–2015). In all cases PAPS was diagnosed before pregnancy and triple marker positivity was defined as simultaneous positivity of lupus anticoagulant, anti-cardiolipin and anti-β2 glycoprotein I antibodies. Ut PI was measured between 23 and 26 weeks' gestation. Pregnancy and neonatal outcomes were collected. Small for gestational age (SGA) was defined as birth weight <10th percentile. Fetal growth restriction (FGR) was defined as SGA delivered before 37 weeks' gestation because of abnormal umbilical artery Doppler. APO was defined as at least either FGR or pre-eclampsia (PE) requiring delivery before 37 weeks' gestation. Diagnostic performances were calculated for ut PI and triple marker positivity and were compared using the Mc Nemar test. P < 0.05 was considered statistically significant. We evaluated 153 pregnancies. There were 9 pregnancies complicated by PE, 11 by SGA and 7 by IUGR. Uterine artery Doppler was recorded in 108 cases, in 7/108 ut PI was ≥ 95th centile. Triple marker positivity was diagnosed in 31/108 pregnancies. Sensitivity and specificity for APO were 30% and 96% for ut PI and 45.5% and 75% for triple marker positivity. Sensitivity was not significantly different between the two tests (p = 0.63), while ut PI was more specific when compared to triple marker positivity (p < 0.001). Ut PI is more specific than triple marker positivity for the detection of APO in women with PAPS.

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