Management of pregnancies after combined screening for pre‐eclampsia at 19–24 weeks' gestation

Autor: Alan Wright, Argyro Syngelaki, Kypros H. Nicolaides, M. Litwinska, David Wright
Rok vydání: 2018
Předmět:
Adult
Mean arterial pressure
medicine.medical_specialty
Population
Gestational Age
Risk Assessment
Ultrasonography
Prenatal
03 medical and health sciences
0302 clinical medicine
Pre-Eclampsia
Predictive Value of Tests
Pregnancy
medicine.artery
medicine
Humans
Mass Screening
Arterial Pressure
Radiology
Nuclear Medicine and imaging
Prospective Studies
030212 general & internal medicine
Ultrasonography
Doppler
Color
Fetal Monitoring
Uterine artery
education
Placenta Growth Factor
education.field_of_study
Vascular Endothelial Growth Factor Receptor-1
030219 obstetrics & reproductive medicine
Proteinuria
Eclampsia
Radiological and Ultrasound Technology
Obstetrics
business.industry
Obstetrics and Gynecology
General Medicine
medicine.disease
Uterine Artery
Blood pressure
Reproductive Medicine
Pulsatile Flow
Gestation
Female
medicine.symptom
business
Biomarkers
Soluble fms-like tyrosine kinase-1
Zdroj: Ultrasound in Obstetrics & Gynecology. 52:365-372
ISSN: 1469-0705
0960-7692
DOI: 10.1002/uog.19099
Popis: To estimate the patient-specific risk of pre-eclampsia (PE) at 19-24 weeks' gestation by maternal factors and combinations of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1). On the basis of the risk of PE, the women would be stratified into high-, intermediate- and low-risk management groups. The high-risk group would require close monitoring for high blood pressure and proteinuria at 24-31 weeks. The intermediate-risk group, together with the undelivered pregnancies from the high-risk group, would have reassessment of risk for PE at 32 weeks to identify those who would require close monitoring for high blood pressure and proteinuria at 32-35 weeks. All pregnancies would have reassessment of risk for PE at 36 weeks to define the plan for further monitoring and delivery.This was a prospective observational study of women attending for an ultrasound scan at 19-24 weeks as part of routine pregnancy care. Patient-specific risks of delivery with PE at 32 and at 36 weeks' gestation were calculated using the competing-risks model to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics and medical history, with multiples of the median (MoM) values of MAP, UtA-PI, PlGF and sFlt-1. Different risk cut-offs were used to vary the proportion of the population stratified into high-, intermediate- and low-risk groups, and the performance of screening for delivery with PE at 32 weeks' gestation and at 32 + 0 to 35 + 6 weeks was estimated.The study population of 16 254 singleton pregnancies included 467 (2.9%) that subsequently developed PE (23 delivered at 32 weeks, 58 delivered at 32 + 0 to 35 + 6 weeks and 386 delivered at ≥ 36 weeks). Using a risk of 1 in 25 for PE at 32 weeks' gestation and risk of 1 in 150 for PE at 36 weeks, the proportion of the population stratified into the high-risk group was about 1% of the total, and the proportion of cases of PE at 32 weeks' gestation contained within this high-risk group varied from about 35% with screening by maternal factors and MAP, to 78% with maternal factors, MAP and UtA-PI, and up to 100% with maternal factors, MAP, UtA-PI and PlGF, with or without sFlt-1. Similarly, the proportion of the population requiring reassessment of risk at 32 weeks' gestation and the proportion of cases of PE at 32 + 0 to 35 + 6 weeks contained within this population varied, respectively, from about 18% and 79% with screening by maternal factors and MAP, to 10% and 90% with maternal factors, MAP, UtA-PI and PlGF, with or without sFlt-1.In the new pyramid of pregnancy care, assessment of risk for PE at 19-24 weeks' gestation can stratify the population into those requiring intensive monitoring at 24-31 weeks and those in need of reassessment at 32 weeks. Copyright © 2018 ISUOG. Published by John WileySons Ltd.
Databáze: OpenAIRE
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