Screening for pre-eclampsia: a systematic review of tests combining uterine artery Doppler with other markers.

AIMS To perform a systematic review of screening for pre-eclampsia (PE) with the combination of uterine artery Doppler (UAD), maternal history, mean arterial pressure and/or maternal serum markers. METHODS We identified eligible studies through a search of Medline, and, for each included study, we assessed the risk of bias and extracted relevant data. We reported the performance of screening tests according to the target population (low- or high-risk), the trimester of screening (first and/or second) and the subset of PE screened for (early and late). RESULTS Several tests provided moderate or convincing prediction of early PE, but screening for late PE was poor. Although UAD is more accurate in the second trimester, we found encouraging results for first-trimester screening when it was combined with other markers. Performance of screening was consistently lower in populations with risk factors for PE in the maternal history. CONCLUSIONS We present encouraging results for the prediction of early PE, even in the first trimester of pregnancy. The different performance of tests in screening for early vs. late PE, and of low- vs. high-risk populations, supports the concept that PE is a heterogeneous disease.