Hypertensive disorders in pregnancy: combined screening by uterine artery Doppler, blood pressure and serum PAPP‐A at 11–13 weeks

Abstract

Objective To explore if the addition of pregnancy-associated plasma protein-A (PAPP-A) to maternal factors and biophysical markers yields a significant improvement in the detection of hypertensive disorders before the clinical onset of disease.Methods Prospective screening study for early preeclampsia (PE), late PE and gestational hypertension (GH) in women attending their first hospital visit at 11 +0 -13 +6 weeks of gestation. The performance of screening for PE and GH by combinations of maternal factors, uterine artery with the lowest pulsatility index (L-PI), mean arterial pressure (MAP) and serum PAPP-A was determined.Results There were 8061 unaffected controls, 37 of whom developed early PE, 128 with late PE and 140 with GH. Compared to the controls, in early PE and late PE MAP and uterine artery L-PI were increased and PAPP-A was decreased. In GH PAPP-A was not significantly different from controls. In screening for a combination of maternal factors, uterine artery L-PI, MAP and PAPP-A the detection rate of early PE was 83.8%, at a 5% false-positive rate. In the prediction of late PE and GH there was no significant improvement from the addition of PAPP-A to the combination of maternal factors, MAP and uterine artery L-PI. ConclusionMeasurement of PAPP-A improves the performance of screening for early PE provided by a combination of maternal factors and biophysical tests at 11-13 weeks.

The diagnostic accuracy of the usage of the <i>Fetal Medicine Foundation</i>’s (FMF) on-line risk calculator with first-trimester ultrasound for screening for preeclampsia in high-risk pregnant Brazilian population

“…We also considered maternal clinical variables (e.g., age, ethnicity, weight, height, body mass index, mode of conception, smoking history, illicit drug use, history of hypertension, history of diabetes and history of systemic lupus erythematous), obstetrical variables (e.g., parity, history of PE in the woman's mother, history of previous PE, history of miscarriages and stillbirths), ultrasound data (e.g., fetal crown-rump length and pulsatility index of uterine arteries) and blood pressure (BP) measured at the time of examination [13,[17][18][19][20][21][22]. No maternal serum biochemical markers were used in the risk assessment for pre-eclampsia; only the clinical information, obstetric ultrasound and BP measurements were used.…”

“…Many current studies have demonstrated the possibility of pre-eclampsia screening between 11 and 13 weeks with promising results [4,13,[16][17][18][19][20][21][22]. This screening focuses on the multivariate analysis of risk associating maternal data, clinical, obstetric, ultrasound and serum marker measurements [19,20].…”

“…This screening focuses on the multivariate analysis of risk associating maternal data, clinical, obstetric, ultrasound and serum marker measurements [19,20].…”

Role of uterine artery Doppler at 12 to 16 weeks of gestation in prediction of pre-eclampsia an observational study

“…Various hemodynamic and biochemical measurements have been found to have limited accuracy as a screening test for this condition. 5,6 Preeclampsia is characterized by an imbalance between prostacyclin and thromboxane A2 production as well as failure of the second wave of trophoblastic invasion of the endometrio-myometrial vasculature. 2 The result is abnormal uteroplacental blood flow and this lead to an idea of using Doppler assessment of uterine artery velocimetry waveforms as the method of screening for this antenatal complication.…”

Early Biometric Lag in the Prediction of Small for Gestational Age Neonates and Preeclampsia

“…Rather, recent evidence has shown that maternal risk factors, serum markers, and uterine artery Doppler studies can be combined in various ways to improve the overall prediction of adverse obstetric outcomes, such as fetal growth restriction and preeclampsia. [4][5][6] Thus, the identification of additional early predictors of adverse outcomes may prove instrumental in the development of effective screening strategies.…”