Uterine artery Doppler waveform analysis has been extensively studied in the second trimester of pregnancy as a predictive marker for the later development of preeclampsia and fetal growth restriction. The use of Doppler interrogation of this vessel in the first trimester has gained momentum in recent years. Various measurement techniques and impedance indices have been used to evaluate the relationship between uterine artery Doppler velocimetry and adverse pregnancy outcomes. Overall, first-trimester Doppler interrogation of the uterine artery performs better in the prediction of early-onset than late-onset preeclampsia. As an isolated marker of future disease, its sensitivity in predicting preeclampsia and fetal growth restriction in low risk pregnant women is moderate, at 40–70%. Multiparametric predictive models, combining first-trimester uterine artery pulsatility index with maternal characteristics and biochemical markers, can achieve a detection rate for early-onset preeclampsia of over 90%. The ideal combination of these tests and validation of them in various patient populations will be the focus of future research.

Objective: Lung ultrasound (LUS) has shown promise as a diagnostic tool for the evaluation of the newborn with respiratory distress. No study has described LUS during ‘normal’ transition. Our goal was to characterise the appearance of serial LUS in healthy newborns from the first minutes after birth until airway liquid clearance is achieved. Study design: Prospective observational study. Setting: Single-centre tertiary perinatal centre in Australia. Patients: Of 115 infants born at ≥35 weeks gestational age, mean (SD) gestational age of 38^6/7 weeks±11 days, mean birth weight of 3380±555 g, 51 were delivered vaginally, 14 via caesarean section (CS) after labour and 50 infants via elective CS. Interventions: We obtained serial LUS videos via the right and left axillae at 1–10 min, 11–20 min and 1, 2, 4 and 24 hours after birth. Main outcome measures: LUS videos were graded for aeration and liquid clearance according to a previously validated system. Results: We analysed 1168 LUS video recordings. As assessed by LUS, lung aeration and airway liquid clearance occurred quickly. All infants had an established pleural line at the first examination (median=2 (1–4) min). Only 14% of infants had substantial liquid retention at 10 min after birth. 49%, 78% and 100% of infants had completed airway liquid clearance at 2, 4 and 24 hours, respectively. Conclusions: In healthy transitioning newborn infants, lung aeration and partial liquid clearance are achieved on the first minutes after birth with complete liquid clearance typically achieved within the first 4 hours of birth. Trial registration number: ANZCT 12615000380594.

Objective: To determine the performance of a multiparametric test comprising maternal risk factors, uterine artery Doppler and ophthalmic artery Doppler in the first trimester of pregnancy for the prediction of pre‐eclampsia (PE).Methods: This prospective observational cohort study recruited patients in the first trimester of pregnancy. Maternal uterine artery and ophthalmic artery Doppler assessments were performed in 440 singleton pregnancies at 11–14 weeks of gestation. Additional history was obtained through participant questionnaires, and follow‐up occurred to discharge postdelivery. The normotensive and pre‐eclamptic groups were compared using parametric (Student's t‐test) and non‐parametric (Mann–Whitney U‐test) tests. Univariable and multivariable logistic regression analyses were performed to determine which biophysical factors, and which of the factors among the maternal characteristics and medical and obstetric history, had a significant contribution to the prediction of PE in a multiparametric model.Results: Thirty‐one (7%) patients developed PE, including nine (2%) who required delivery before 34 weeks (early PE) and 22 (5%) with late PE. There were statistically significant differences in uterine artery pulsatility index (UtA‐PI) and ophthalmic artery first diastolic peak (PD1) mean values between the PE and control groups. In a multiparametric model, both UtA‐PI and PD1 achieved a 67% detection rate for early PE, although when combined, the detection rate only increased to 68%.Conclusions: The efficiency of ophthalmic artery PD1 in the first trimester as a predictive marker for the later development of PE was approximately equal to that described for uterine artery Doppler. Although these findings do not support the replacement of uterine artery Doppler analysis in multiparametric predictive models for PE, they do provide novel insights into first‐trimester maternal systemic vascular changes that precede the clinical development of this condition. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.