Systolic, Diastolic and Mean Arterial Pressure at 30-33 Weeks in the Prediction of Preeclampsia

Abstract

Objective: To investigate the potential value of measuring mean arterial pressure (MAP), systolic (sBP) and diastolic (dBP) blood pressure at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. Methods: Screening study in singleton pregnancies at 30-33 weeks' gestation including 4,294 that were unaffected by PE, gestational hypertension (GH) or delivery of small-for-gestational-age neonates (normal group), 145 that subsequently developed PE [37 cases requiring delivery at 34-37 weeks (intermediate PE) and 108 delivering at or after 38 weeks (late PE)] and 161 that developed GH. The a priori risks for intermediate and late PE from maternal demographic characteristics and medical history were determined. The a posteriori risks were calculated by combining the a priori risks with the likelihood ratios for MAP, sBP and dBP, which were calculated from fitted bivariate gaussian distributions. Results: The mean multiple of median MAP, sBP and dBP were significantly higher in the intermediate and late PE groups than in the normal group. In screening by a combination of maternal characteristics and MAP, the estimated detection rates of intermediate and late PE, at a false-positive rate of 10%, were 70.3 and 62.0%, respectively. The respective detection rates for sBP were 62.2 and 59.3% and for dBP were 62.2 and 57.4%. Conclusion: Combined testing by maternal characteristics and blood pressure at 30-33 weeks could effectively identify women at high risk for subsequent development of PE.

Towards an Integrated Third-Trimester Screening in Pregnancy

“…This research has already started. This issue of Fetal Diagnosis and Therapy publishes four studies performed by the Fetal Medicine Foundation which provide important evidence supporting that prediction of late-onset PE is possible by means of either uterine artery Doppler or angiogenic factors [9,10,11,12]. These results are in line with another very recent study from the United States [13].…”

Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term

“…Recently it has been shown that uterine artery Doppler indices in the third trimester might be of clinical value [40][41][42][43][44]. Some studies have suggested that the predictive value of third trimester uterine artery Doppler is comparable to that of umbilical artery Doppler when predicting adverse pregnancy outcomes in late onset FGR [45][46][47].…”

Competing Risk Model in Screening for Preeclampsia by Mean Arterial Pressure and Uterine Artery Pulsatility Index at 30-33 Weeks' Gestation

“…Two previous screening studies at 30-33 weeks' gestation examined 4,855 pregnancies and reported that at FPR of 5% screening by a combination of maternal characteristics and uterine artery PI or MAP detected 49 and 57%, respectively, of intermediate PE requiring delivery at 34-37 weeks and 37 and 49% of late PE with delivery at ≥38 weeks [27,28]. In the present extended series, we used a survival time model to treat gestational age at delivery for PE as a continuous, rather than categorical variable, allowing estimation of performance of screening for any desired interval between screening and delivery.…”