Diagnostic Performance of First-Trimester Placental Shear Wave Elastography for Predicting Hypertensive Disorders of Pregnancy During the 11- to 14-Week Scan in a Tertiary Care Hospital.

Introduction Hypertensive disorders of pregnancy (HDP) are important causes of maternal and perinatal morbidity. Although clinical hypertension usually becomes evident after 20 weeks of gestation, abnormal placentation begins much earlier. Placental shear wave elastography (SWE) is a quantitative ultrasound technique that measures tissue stiffness and may help identify early biomechanical changes in the placenta before clinical disease becomes apparent. This study evaluated the association and diagnostic performance of placental SWE performed during the 11- to 14-week scan for predicting the later development of HDP. Methods This hospital-based prospective analytical observational study was conducted in the Department of Radiodiagnosis, Central Referral Hospital, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim. Pregnant women attending routine first-trimester nuchal translucency and nasal bone (NTNB) scans were enrolled after informed consent. Placental SWE was performed using a Mindray DC-80 X Insight ultrasound system (Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China) with an SC5-1E curvilinear probe. Three approximately 5 mm regions of interest were placed within the placental parenchyma, avoiding placental margins, cord insertion, placental lakes, focal heterogeneity, and excessive probe pressure. Averaged EMAX, EMEAN, and EMIN values were used for analysis. Women were followed at 28, 32, and 36 weeks and at 40 weeks or delivery. Group comparison and receiver operating characteristic (ROC) curve analysis were performed. Results Of 80 enrolled women, five were excluded due to loss to follow-up or abortion. The final analysis included 75 women. Among these women, 57 remained normotensive, and 18 developed HDP. The HDP group included seven women with pregnancy-induced hypertension (PIH)/gestational hypertension and 11 with preeclampsia. No case of eclampsia was recorded. EMAX Average was significantly higher in the HDP group than in the non-HDP/normotensive group (13.09 ± 4.79 kPa vs 10.24 ± 4.02 kPa; p = 0.015). EMEAN Average was also significantly higher (7.33 ± 2.88 kPa vs 5.93 ± 2.07 kPa; p = 0.027), while EMIN Average did not show a statistically significant difference (4.11 ± 1.62 kPa vs 3.47 ± 1.38 kPa; p = 0.105). On ROC analysis, EMAX Average showed the best diagnostic performance, with an area under the curve of 0.682 (95% CI: 0.564-0.785; p = 0.009). At a cut-off value of >11.71 kPa, sensitivity was 61.1%, and specificity was 73.7%. EMEAN Average showed an area under the curve of 0.643 (p = 0.058), while EMIN Average showed an area under the curve of 0.607 (p = 0.157). Conclusion First-trimester placental SWE was feasible during the routine 11- to 14-week ultrasound scan. EMAX Average showed the best diagnostic performance for later HDP, while EMEAN Average showed a significant group difference but did not reach statistical significance on ROC analysis. Overall diagnostic performance was moderate. Placental SWE should therefore be considered a complementary imaging biomarker rather than a standalone screening test for HDP.