An observational study of evaluation of extended first trimester screening test to predict early preterm pre-eclampsia in pregnant women
Keywords:Pre-eclampsia, PAPP-A, MAP, Uterine artery pulsatility index
Background: Pre-eclampsia is hypertensive disorder with several complications. Contributes to increased maternal mortality and morbidity. Pre-eclampsia is associated with pre term labour, IUGR and several other complications like end organ failure in mother. So, it is important to diagnose early and take appropriate steps to mitigate maternal mortality and morbidity. Aim was to detect and predict early preterm pre-eclampsia using extended first trimester screening test in pregnant women. Objectives were to assess the sensitivity and specificity of extended first trimester screening test to predict development pre-eclampsia in pregnancy.
Methods: Method used in this study was observational study.
Results: All three parameters, PAPPA, mean arterial pressure (MAP) and uterine artery pulsatility index found to be significantly associated in predicting early preterm preeclampsia
Conclusions: This screening test enables us to predict preeclampsia before its clinical presentation. It can be used as a reliable and a cost-effective screening test. This will help prevent the progression of the disease by taking necessary timely interventions such as ecosprin administration, close and frequent follow up of screen positive mothers. Thus, it is useful tool in reducing the burden of maternal and fetal morbidity on the health system. This study also has confounding factors due to starting of prophylactic treatment with ecosprin based on ACOG/ NICE guidelines, which increased false positive rate.
Committee- E, Committee- R. FOGSI-GESTOSIS-ICOG Hypertensive Disorders in Pregnancy (HDP). Good Clin Practice Recommendations. 2019:2019;1-25.
Poon LC, Stratieva V, Piras S, Piri S, Nicolaides KH. Hypertensive disorders in pregnancy: combined screening by uterine artery Doppler, blood pressure and serum PAPP-A at 11-13 weeks. Prenat Diagn. 2010;30(3):216-23.
Mayrink J, Souza RT, Feitosa FE, Rocha Filho EA, Leite DF, Vettorazzi J, et al. Mean arterial blood pressure: Potential predictive tool for preeclampsia in a cohort of healthy nulliparous pregnant women. BMC Pregnancy Childbirth. 2019;19(1):1-8.
Gallo D, Poon LC, Fernandez M, Wright D, Nicolaides KH. Prediction of preeclampsia by mean arterial pressure at 11-13- and 20-24-weeks’ gestation. Fetal Diagn Ther. 2014;36(1):28-37.
Sajith M, Nimbargi V, Modi A, Sumariya R. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J pharma Sci Res. 2014;5(04):163-70.
Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis and management recommendations for international practice. Pregnancy Hypertens. 2018;13:291-310.
Phillips JK, Janowiak M, Badger GJ, Bernstein IM. Evidence for distinct preterm and term phenotypes of preeclampsia. J Matern Neonatal Med. 2010;23(7):622-6.
Pijnenborg R, Bland JM, Robertson WB, Brosens I. Uteroplacental arterial changes related to interstitial trophoblast migration in early human pregnancy. Placenta. 1983;4(4):397-413.
Redman CW, Sargent IL, Staff AC. IFPA senior award lecture: Making sense of pre-eclampsia-Two placental causes of preeclampsia? Placenta. 2014;35:S20-5.
Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019;366:1-15.
Kalousová M, Muravská A, Zima T. Pregnancy-associated plasma protein a (PAPP and preeclampsia. Advances in Clinical Chemistry. 2014;63:169-209.
Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre- eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynecol Obstet. 2019;145(S1):1-33.
Chaemsaithong P, Pooh RK, Zheng M, Ma R, Chaiyasit N, Tokunaka M, et al. Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population. Am J Obstet Gynecol. 2019;221(6):650.e1-16.
Hypertension G. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-60.
NICE. Hypertension in pregnancy: diagnosis and management (NG133). NICE Guidel. 2020;(2019):55.
Miller RS, Rudra CB, Williams MA. First-Trimester Mean Arterial Pressure and Risk of Preeclampsia. Am J Hypertens. 2007;20(5):573-8.
Gasse C, Boutin A, Coté M, Chaillet N, Bujold E, Demers S. First-trimester mean arterial blood pressure and the risk of preeclampsia: The Great Obstetrical Syndromes (GOS) study. Pregnancy Hypertens. 2018;12(7):178-82.
Khong SL, Kane SC, Brennecke SP, Da Silva Costa F. First-trimester uterine artery doppler analysis in the prediction of later pregnancy complications. Dis Markers. 2015;2015.
Gómez O, Figueras F, Fernández S, Bennasar M, Martínez JM, Puerto B et al. Reference ranges for uterine artery mean pulsatility index at 11-41 weeks of gestation. Ultrasound Obstet Gynecol. 2008;32(2):128-32.
Poon LCY, Akolekar R, Lachmann R, Beta J, Nicolaides KH. Hypertensive disorders in pregnancy: Screening by biophysical and biochemical markers at 11-13 weeks. Ultrasound Obstet Gynecol. 2010;35(6):662-70.
Chaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Am J Obstet Gynecol. 2020;226(2S):S1071-97.
Rolnik DL, Wright D, Poon LCY, Syngelaki A, O'Gorman N, de Paco Matallana C, et al. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol. 2017;50(4):492-5.
Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics, 25e Eds. McGraw Hill, 2018. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=1918§ionid=185041395. Available at 20 June 2021.