OC14.02: The additive value of HE4 novel tumor marker to the IOTA simple rules in the management of ovarian masses

Abstract

The aim of this study was to compare maternal cardiac function in a cohort of women who were high risk for early (<34 weeks) pre-eclampsia (ePET) and subsequently had normal or adverse outcomes. Methods: This was a prospective study of maternal cardiac function in women deemed high risk of ePET by first trimester screening at 12 weeks. Serial echocardiographic assessment (Accuvix XG, Samsung Medison with P2-4BA probe, Seoul, Korea), of maternal cardiac output (CO) and total peripheral resistance (TPR) were calculated at 14, 18, 24 and 30 weeks. Pregnancy outcomes were recorded and defined as being normal or adverse (the development of hypertension, delivery of an infant of low birthweight (<5th centile) or preterm birth (<37 weeks' gestation). The cardiovascular parameters were compared between the two groups. Results: 31 women who had a high risk ePET screen participated; 18 with a normal and 13 (42%) with an adverse pregnancy outcome. The adverse outcome group included 3 (9.7%) pre-eclampsia, 3 (9.7%), gestational hypertension, 4 (12.9%) preterm birth and 4 (12.9%) infants with low birthweight. Mean CO (L/min) values were significantly lower in those with an adverse outcome; 4.99 vs 4.17: P=0.04 at 14 weeks and 5.35 vs 4.61: P<0.01 at 30 weeks gestation. The mean TPR (dyne/sec/cm-5) was significantly higher in the adverse outcome group at 14 weeks (1431 vs. 1722: P=0.04), 24 weeks (1316 vs. 1577: P<0.01) and 30 weeks (1323 vs. 1658: P<0.01) gestation. Conclusions: Women who are high risk for ePET and subsequently have an abnormal outcome have evidence of abnormal cardiac function with lower CO and higher TPR as early as 14 weeks gestation. These parameters may be useful as a second tier screening tool for pregnancies deemed 'high risk' by first trimester screening and may help reduce the false positive rate and increase the positive predictive value of the screening process.