How to perform first trimester combined screening for pre‐eclampsia

Reddy, Maya; Springhall, Edward; Rolnik, Daniel L.; Costa, Fabrício da Silva

doi:10.1002/ajum.12111

Cited by 2 publications

(4 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transabdominal or transvaginal approaches are possible, although transabdominal is preferred as transvaginal measurements produce higher PI values. 52 The uterine artery Doppler parameter is the most at risk of error given that it is highly operator dependent. 53 Accurate acquisition can also be impacted by patient factors such as patient obesity.…”

Section: Uterine Artery Doppler Analysismentioning

confidence: 99%

“…53 When used in isolation, the Ut-A PI in the first trimester has a sensitivity of 48% and specificity of 92% for the prediction of early-onset PE. 52…”

Section: Uterine Artery Doppler Analysismentioning

confidence: 99%

“…PlGF is a vascular endothelial growth factor which is essential for angiogenesis of the uteroplacental circulation, low levels of which precede the clinical manifestations of disease. 52 PlGF measured at 11-13 weeks' gestation, as an isolated screening tool, has a detection rate for preeclampsia requiring delivery before and after 34 weeks' gestation of 51% and 32% respectively, at a 10% FPR. 55 PAPP-A is a glycoprotein produced by the embryo and the trophoblast and has a role in the cleavage of insulin-like growth factor, which regulates placental and fetal development and growth.…”

Section: Serum Biomarkersmentioning

confidence: 99%

“…55 PAPP-A is a glycoprotein produced by the embryo and the trophoblast and has a role in the cleavage of insulin-like growth factor, which regulates placental and fetal development and growth. 52 It is reduced in pregnancies with preeclampsia and as an isolated screening tool has a detection rate of 21.9% at a FPR of 10%. 56 The analysis of these biomarkers can be undertaken by automated machines, known to provide rapid and reproducible results.…”

Section: Serum Biomarkersmentioning

confidence: 99%

See 3 more Smart Citations

Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers

Malone¹,

Yahya²,

Kane³

2022

IJWH

View full text Add to dashboard Cite

Preeclampsia is a common and important complication of pregnancy, one with potentially significant morbidity and even mortality to both mother and baby. Identifying those at high risk of developing the condition is helpful as there is evidence that the incidence of preeclampsia can be reduced with low dose aspirin taken in pregnancy. Accurately predicting the risk of preeclampsia allows for more targeted aspirin prophylaxis and a greater opportunity for early detection of maternal and/or fetal complications associated with impaired placentation through a schedule of enhanced antenatal surveillance. Traditional preeclampsia prediction models use maternal characteristics and risk factors and have been shown to be of low predictive value. Multiparametric screening tests combine patient characteristics with serum biomarkers and ultrasound Doppler indices and have been shown to be more effective at detecting those at high risk of preeclampsia -more specifically, early-onset preeclampsia (onset of preeclampsia <34 weeks' gestation). Multiparametric screening has now been validated in different populations. The true cost effectiveness of a multiparametric screening model for preeclampsia screening is not yet fully known and will vary depending on the clinical setting. Despite the growing body of evidence for its improved detection rates, first trimester preeclampsia screening using multiparametric models is not widely implemented and is not part of the recommendations for antenatal screening from most international bodies. The International Federation of Gynecology and Obstetrics has advised universal preeclampsia screening using maternal risk factors and biomarkers and has strongly encouraged its promotion worldwide. Various barriers to implementation must be considered such as the immediate cost of equipment and training, the need for audit and quality control, and the expected benefit to the population. Low to middle income settings may require a pragmatic approach to the implementation of multiparametric screening given limited resources.

show abstract

Section: Uterine Artery Doppler Analysismentioning

confidence: 99%

“…53 When used in isolation, the Ut-A PI in the first trimester has a sensitivity of 48% and specificity of 92% for the prediction of early-onset PE. 52…”

Section: Uterine Artery Doppler Analysismentioning

confidence: 99%

Section: Serum Biomarkersmentioning

confidence: 99%

Section: Serum Biomarkersmentioning

confidence: 99%

See 2 more Smart Citations

Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers

Malone¹,

Yahya²,

Kane³

2022

IJWH

View full text Add to dashboard Cite

show abstract

Guidelines—similarities and dissimilarities: a systematic review of international clinical practice guidelines for pregnancy hypertension

Scott

Gillon

Pels

et al. 2022

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

This study aimed to review pregnancy hypertension clinical practice guidelines to inform international clinical practice and research priorities. STUDY ELIGIBILITY CRITERIA: Relevant national and international clinical practice guidelines, 2009-19, published in English, French, Dutch or German. STUDY APPRAISAL AND SYNTHESIS METHODS: Following published methods and prospective registration (CRD42019123787), a literature search was updated. CPGs were identified by 2 authors independently who scored quality and usefulness for practice (Appraisal of Guidelines for Research and Evaluation II instrument), abstracted data, and resolved any disagreement by consensus. RESULTS: Of note, 15 of 17 identified clinical practice guidelines (4 international) were deemed "clinically useful" and had recommendations abstracted. The highest Appraisal of Guidelines for Research and Evaluation II scores were from government organizations, and scores have improved over time. The following were consistently recommended: (1) automated blood pressure measurement with devices validated for pregnancy and preeclampsia, reflecting increasing recognition of the prevalence of white-coat hypertension and the potential usefulness of home blood pressure monitoring; (2) use of dipstick proteinuria testing for screening followed by quantitative testing by urinary protein-to-creatinine ratio or 24-hour urine collection; (3) key definitions and most aspects of classification, including a broad definition of preeclampsia (which includes proteinuria and maternal end-organ dysfunction, including headache and visual symptoms and laboratory abnormalities of platelets, creatinine, or liver enzymes) and a recognition that it can worsen after delivery; (4) preeclampsia prevention with aspirin; (5) treatment of severe hypertension, most commonly with intravenous labetalol, oral nifedipine, or intravenous hydralazine; (6) treatment for nonsevere hypertension when undertaken, with oral labetalol (in particular), methyldopa, or nifedipine, with recommendations against the use of renin-angiotensin-aldosterone inhibitors; (7) magnesium sulfate for eclampsia treatment and prevention among women with "severe" preeclampsia; (8) antenatal corticosteroids for preterm birth but not hemolysis, elevated liver enzymes, and low platelet count syndrome; (9) delivery at term for preeclampsia; (10) a focus on usual labor and delivery care but avoidance of ergometrine; and (11) an appreciation that long-term health complications are increased in incidence, mandating lifestyle change and risk factor modification. Lack of uniformity was seen in the following areas: (1) the components of a broad preeclampsia definition (specifically respiratory and gastrointestinal symptoms, fetal manifestations, and biomarkers), what constitutes severe preeclampsia, and whether the definition has utility because at present what constitutes severe preeclampsia by some guidelines that mandate proteinuria now defines any preeclampsia for most other clinical practice guidelines; (2) how preeclampsia r...

show abstract

How to perform first trimester combined screening for pre‐eclampsia

Cited by 2 publications

References 48 publications

Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers

Reviewing Accuracy of First Trimester Screening for Preeclampsia Using Maternal Factors and Biomarkers

Guidelines—similarities and dissimilarities: a systematic review of international clinical practice guidelines for pregnancy hypertension

Contact Info

Product

Resources

About