(687) Umbilical Artery Doppler Pulsatility Index as a Predictive Biomarker for Preterm Premature Rupture of Membranes

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Amanda J. Jones, MD (she/her/hers)

Resident Physician
Christiana Care Health System
Newark, DE, United States

Coauthor(s)

EG

Ernest Graham, MD

Division of Maternal-Fetal Medicine
Johns Hopkins School of Medicine
Baltimore, Maryland, United States
Irina Burd, MD, PhD (she/her/hers)

Professor and Chair
University of Maryland
Baltimore, Maryland, United States
Ahizechukwu C. Eke, MD, MPH, PhD

Associate Professor of Gynecology & Obstetrics
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States

Objective: Although known risk factors for preterm premature rupture of the fetal membranes (PPROM) can be assessed, otherwise predicting PPROM is not currently clinically feasible. The objective of this study was to assess the predictive value of umbilical artery Doppler pulsatility index (UA-PI) alone for PPROM, and when combined with previously established predictive risk factors.

Study Design: This was a retrospective cohort study of liveborn non-anomalous chromosomally normal infants admitted to the neonatology intensive care unit at a single tertiary care center from April 2009 to March 2016. All cases had umbilical artery (UA) Doppler studies routinely measured during second and third trimester ultrasounds. The pre-rupture UA-PI of patients whose pregnancies were complicated by PPROM were compared to gestational age-matched controls without PPROM. The area under the receiver operating characteristic curve (AUC) was used to estimate the predictive ability of pulsatility index (UA-PI) for predicting PPROM, and the Liu method was used to identify the UA-PI threshold that maximized both sensitivity and specificity. The AUC, sensitivity, and specificity were also assessed when maternal age, parity, and singleton vs multiple gestation as predictive variables were combined by forward selection with UA-PI.

Results: Of 1,145 high-risk gestations studied, 262 (23%) were complicated by PPROM and 883 (77%) were without PPROM. Multivariable analysis identified elevated UA-PI (AOR 1.24, 95% CI 1.18-1.31, p=0.002) as an independent risk factor for PPROM. The AUC for UA-PI was 0.57 (95% CI 0.54-0.61) for an elevated UA-PI. When maternal age, parity, and singleton vs multiple gestation as predictive variables were combined by forward selection with UA-PI, the AUC increased to 0.65 (95% CI 0.62-0.68). The optimal UA-PI threshold was 0.95 (26% sensitivity, 73% specificity).

Conclusion: Elevated UA-PI is moderately predictive of PPROM, and inclusion in a predictive model for PPROM in high-risk pregnancies may be justified pending validation.