(472) Maternal transocular ultrasound for prediction of hypertensive disorders of pregnancy

Prospective cohort study (IRB#H-53999) of gravidas undergoing prenatal care/obstetric ultrasound and delivered at an academic institution (2/2024 - 6/2025). Gravidas with preexisting chronic hypertension, maternal ocular anomalies, fetal growth restriction (FGR) and fetal anomalies were excluded. A handheld 3-12 MHz linear array ultrasound transducer (V-scan, GE) was used to obtain 10-second cine clips and still images of both eyes in the transverse plane during the 2^nd trimester. ONSD was measured 3mm behind the papilla at two different time points in each clip. One measurement was made for each still image. ONSD for both eyes were averaged to determine mean ONSD for each patient. The Shapiro-Wilk test and appropriate parametric/non-parametric tests for continuous variables and proportions were used. ROC curve used to test diagnostic accuracy. p < 0.05 denoted significance.

Results:
Table 1 shows demographic data. 34 patients were included after 9 were excluded for: new diagnosis of glaucoma (n=1), chronic hypertension (n=5), and FGR (n=3). 8/34 (24%) developed a hypertensive disorder of pregnancy (HTN group) per ACOG criteria 18.3 ± 0.7 weeks after measurement. Mean ONSD in the 2nd trimester was significantly higher in the HTN group compared to the normotensive (Control) group: 6.04±0.24 (n=8) vs 5.47±0.13 mm (n=26), p = 0.04. 50% of the HTN group had ONSD > 6.1 vs 14.8% of Controls, p = 0.06. ROC analysis demonstrated an AUC of 0.745 with a PPV of 0.5 (95% CI 0.15-0.85) and NPV of 0.85 (95% CI 0.71-0.98).   

Conclusion:
ONSD in the second trimester may be an easily applied, non-invasive, inexpensive predictor of the subsequent development of hypertensive disorders of pregnancy though is likely most useful in ruling out hypertension if normal.