Objective
To assess the effectiveness of second trimester 24‐hour ambulatory blood pressure measurement as a screening test for pre‐eclampsia.
Design
Prospective interventional study.
Setting
John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London.
Subjects
One hundred and sixty‐two normotensive nulliparous women recruited at hospital booking clinics.
Intervention
Ambulatory blood pressure was measured at 18 and 28 weeks gestation using the TM2420 monitor.
Main outcome measure
The development of pre‐eclampsia.
Results
Awake systolic and mean arterial pressures were significantly increased (P<0.02) at 18 weeks in those who later developed pre‐eclampsia. Those differences were more apparent at 28 weeks at which time the diastolic pressure was also increased (P<0.01). At both stages of gestation the higher readings were sustained during sleep so that the awake‐sleep differences were similar in relation to each outcome. The group with incipient pre‐eclampsia had a significantly faster heart rate at both 18 and 28 weeks (P<0.002) The sensitivity in predicting pre‐eclampsia for a mean arterial pressure of 85 mmHg or greater at 28 weeks was 65%, with a positive predictive value of 31 %. The sensitivity and positive predictive value for a test combining a mean arterial pressure of 85 mmHg or greater and a heart rate of 90 bpm or greater were 53% and 45%, respectively.
Conclusion
Although second trimester ambulatory blood pressure is significantly increased in women who later develop pre‐eclampsia, the predictive values for blood pressure alone are low. The efficiency of the test is increased by combining the awake ambulatory heart rate and blood pressure measurement together. If an effective method for preventing pre‐eclampsia becomes available (commencing at 28 weeks gestation), then awake ambulatory blood pressure and heart rate may have some clinical value as a screening test.
Pseudoenhancement of renal cysts significantly correlates with size smaller than 1 cm and central location. Although pseudoenhancement increases with larger numbers of detectors, the correlation was not statistically significant. Cysts in the 1- to 1.5-cm range have a 19% likelihood of pseudoenhancement.
Objective
To determine the relation between the inactive urinary kallikreimcreatinine ratio (IUK:Cr) and the angiotensin sensitivity test (AST) at 28 weeks of gestation and to assess each as a screening test for pre‐eclampsia.
Design
Prospective interventional study.
Subjects
Four hundred and fifty‐nine normotensive nulliparous women recruited from hospital antenatal clinics.
Setting
John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London.
Interventions
A urine sample for IUK:Cr measurement was provided before performing the AST at 28 weeks of gestation. Those women who demonstrated increased sensitivity to angiotensin II were entered into a randomised placebo controlled trial of low dose aspirin for the prevention of pre‐eclampsia (CLASP).
Main outcome measures
The development of pre‐eclampsia.
Results
The IUK:Cr ratio was significantly lower in those women who showed increased sensitivity to angiotensin II (P < 0.0001 Student's t test). The sensitivity and specificity for detecting pre‐eclampsia were, respectively, 22% and 85% for the AST and 67% and 75% for the IUK:Cr. Low‐dose aspirin (60 mg) had no effect on the pregnancy outcome.
Conclusion
There appears to be some relation between the IUK:Cr and AST tests in pregnancy. However, in this population, the IUK:Cr ratio was a better screening test for pre‐eclampsia than the AST, but overall neither test was a powerful predictor for the syndrome.
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