Screening for pre‐eclampsia and fetal growth restriction by uterine artery Doppler at 11–14 weeks of gestation

Martin, A.; Bindra, Ranjna; Curcio, Patrizia; Cicero, S.; Nicolaides, Kypros H.

doi:10.1046/j.0960-7692.2001.00594.x

Cited by 378 publications

(347 citation statements)

References 17 publications

(9 reference statements)

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“…Whether further improvements could be made using a combination of PAPP-A and first-trimester uterine artery Doppler remains to be seen. Certainly, early uterine artery Doppler measurement does seem to have less discrimination than that done at 22 to 24 weeks (Martin et al, 2001) although there is little or no correlation between reduced levels of PAPP-A in the first trimester and uterine artery Doppler either in the first trimester (Prefumo et al, 2006) or second trimester (Spencer et al, 2005b). The early identification of women at increased risk of developing pre-eclampsia by a combination of low PAPP-A alone or in combination with other markers such as inhibin, activin or PP13 (Ong et al, 2004;Spencer et al, 2006bSpencer et al, , 2007cNicolaides et al, 2006), along side uterine artery Doppler measurement and maternal factors (Yu et al, 2005) may allow increased surveillance or early possible therapeutic interventions with low dose aspirin in an attempt to arrest the disease progression.…”

Section: Discussionmentioning

confidence: 99%

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

Spencer

Cowans²,

Nicolaides³

2007

Prenatal Diagnosis

183

113

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Background Low levels of pregnancy associated plasma protein-A (PAPP-A) have been previously shown to be associated with pregnancies that subsequently develop pre-eclampsia. The objective of this study was to establish the relative risk for pre-eclampsia at various PAPP-A levels as an aid to counselling and follow up of pregnancies.Methods Maternal serum PAPP-A and free ß-human chorionic gonadotropin (ß-hCG) levels at 11 to 13 weeks of gestation from 224 singleton pregnancies that subsequently developed pre-eclampsia were compared to those from 47 770 normal singleton pregnancies resulting in live births after 37 weeks with birth weight greater than or equal to the 10th centile of normal for gestation. In all cases, the measured PAPP-A and free ß-hCG levels were expressed as multiple of the median (MoM). The association between metabolite levels and the incidence of pre-eclampsia was assessed by comparing the relative incidence at a number of MoM cut-offs and at various centiles. At various marker levels, the likelihood ratio for pre-eclampsia was also calculated. ResultsIn the pre-eclampsia group the median PAPP-A MoM was significantly reduced (0.772 MoM, p < 0.0001) whilst the median free β-hCG MoM was not different from controls (0.981 MoM, p = 0.26). With decreasing levels of PAPP-A, the likelihood ratio for pre-eclampsia increased. At the 5th centile of normal (PAPP-A MoM 0.415) the odds ratio was increased 4-fold and at this cut-off 15% of cases of pre-eclampsia would be identified. ConclusionsThe graphical presentation of a likelihood ratio curve for pre-eclampsia at any PAPP-A MoM level is likely to be useful in counselling women with low levels of PAPP-A and a normal karyotype. Use of low levels of PAPP-A for selecting women for further follow-up with uterine artery Doppler may further improve the clinical discrimination.

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Section: Discussionmentioning

confidence: 99%

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

Spencer

Cowans²,

Nicolaides³

2007

Prenatal Diagnosis

183

113

View full text Add to dashboard Cite

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“…Studies using first-trimester 9,35,36 or secondtrimester [37][38][39] Doppler sonography alone or combined with maternal serum markers 4,40-43 have had some success, but sensitivity and PPVs are low, or the tests were expensive or invasive. Accurate identification of women at risk, particularly those at risk of early-onset disease, would have real clinical benefits.…”

Section: Discussionmentioning

confidence: 99%

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Khalil

Cooper

Harrington

2008

BJOG

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Objective To investigate whether first-trimester arterial pulse wave analysis (PWA) can predict pre-eclampsia.Design This was a prospective screening study.Setting The Homerton University Hospital, a London teaching hospital.Population Two hundred and ten low-risk women with a singleton pregnancy were analysed.Methods Radial artery pulse waveforms were measured between the 11 +0 and 13 +6 weeks of gestation and the aortic waveform derived by applying a generalised transfer function. Augmentation pressure (AP) and augmentation index at heart rate of 75 beats per minute (AIx-75), measures of arterial stiffness, were calculated. The multiple of the gestation-specific median in controls for AP and AIx-75 were calculated. Logistic regression models were developed and their predictive ability assessed using the area under the receiver operator curve.Main outcome measures Prediction of pre-eclampsia by AIx-75.Results Fourteen (6.7%) women developed pre-eclampsia, and 196 remained normotensive. Eight of the 14 women developed pre-eclampsia before 34 weeks of gestation (early-onset pre-eclampsia). For a false-positive rate of 11%, AIx-75 had a detection rate of 79% for all cases of pre-eclampsia and 88% for early-onset pre-eclampsia.Conclusion First-trimester arterial PWA can play a significant role in understanding the pathophysiology of pre-eclampsia and may play a role in early screening.

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“…They also felt that the tests' usefulness was limited by its poor specificity and highlighted the need for prospective studies to reproduce their results. A larger and more recent study of 3324 'low risk' women at 11 -14 weeks demonstrated bilateral 'notching' in 55% and concluded that this was 'unlikely to be useful in screening for pregnancy complications' 5 . We are not given outcome data for the 30 women (25%) who did not have bilateral 'notching' in the current study, but I would be surprised if they were statistically different to those 43 women who received placebo.…”

Section: Sirmentioning

confidence: 99%

“…Before this trial 1 , there were five randomised trials 3 -7 , which evaluated the effect of aspirin to prevent pre-eclampsia in women identified to be at high risk with an abnormal uterine artery Doppler test. Of these, four trials 3 -5,7 showed a trend towards benefit, but in three 4,5,7 , the…”

mentioning

confidence: 94%

Low dose acetylsalicylic acid in prevention of pregnancy‐induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches

Somerset

2002

BJOG

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Screening for pre‐eclampsia and fetal growth restriction by uterine artery Doppler at 11–14 weeks of gestation

Abstract: Uterine artery Doppler at 11-14 weeks of gestation identifies a high proportion of women who develop severe pre-eclampsia and/or fetal growth restriction.

Cited by 378 publications

References 17 publications

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

Pulse wave analysis: a preliminary study of a novel technique for the prediction of pre‐eclampsia

Low dose acetylsalicylic acid in prevention of pregnancy‐induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches

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