Low concordance between first-trimester ophthalmic artery Doppler and uterine artery–based algorithms for preeclampsia risk assessment: cross-sectional agreement study
Main Article Content
Abstract
Background: Preeclampsia is a complex multisystem syndrome that remains one of the leading causes of maternal and neonatal morbidity and mortality. The first-trimester screening integrates maternal factors, mean arterial pressure, biochemical markers, and uterine artery Doppler indices. Ophthalmic artery (OA) Doppler has been proposed as a complementary marker reflecting maternal systemic and cerebral hemodynamic adaptation. The concordance between –based assessment and established uterine artery–based models remains insufficiently characterized.
Objective: To evaluate the agreement between a first-trimester ophthalmic artery Doppler–based algorithm and the conventional uterine artery–based algorithm for preeclampsia risk classification.
Methods: This cross-sectional agreement study included 116 pregnancies evaluated between 11+0 and 13+6 weeks of gestation. Risk was calculated using two Fetal Medicine Foundation algorithms: Algorithm 1 (A1), incorporating uterine artery pulsatility index and Algorithm 2 (A2), incorporating OA peak systolic velocity PSV ratio. Agreement was assessed using crude agreement, Cohen’s kappa with 95% confidence interval, prevalence-adjusted bias-adjusted kappa (PABAK), McNemar’s test for paired proportions, and odds ratio with 95% confidence interval. Statistical significance was set at p < 0.05.
Results: Algorithm 1 classified 23.3% of women as high risk, whereas Algorithm 2 classified 15.5% as high risk. Only 1.7% were classified as high risk by both methods. Crude agreement was 64.7%. Cohen’s kappa indicated poor agreement beyond chance (κ = −0.12; 95% CI −0.40 to 0.16). McNemar’s test was not statistically significant (p = 0.21). The odds ratio for concordant high-risk classification was 0.36 (95% CI 0.08–1.70). PABAK indicated fair agreement after prevalence adjustment.
Conclusion: First-trimester ophthalmic artery–based and uterine artery–based risk algorithms demonstrated limited concordance. Prospective outcome-based studies are required to determine the clinical relevance of these findings.
Article Details
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