| Abstract | Objective: To estimate the patient-specific risk of preeclampsia (PE) at 35-37 weeks’ gestation by a combination of maternal characteristics and medical history with multiple of the median (MoM) values of mean arterial pressure (MAP), uterine artery pulsatility index (UTPI), serum placental growth factor (PLGF) and serum soluble fms-like tyrosine kinase-1 (sFLT-1) and stratify women into high-, intermediate- and low-risk management groups. Methods: This was a prospective observational study in women attending for a third-trimester ultrasound scan at 35-37 weeks as part of routine pregnancy care. Patient-specific risks of delivery with PE at <4 weeks from assessment and PE at <42 weeks’ gestation were calculated using the competing risks model to combine the prior risk from maternal characteristics and medical history with MoM values of MAP, UTPI, PLGF and sFLT-1. On the basis of these risks the population was stratified into high-, intermediate- and low-risk groups. Different risk cut-offs were used to vary the proportion of the population stratified into each risk category and the performance of screening for delivery with PE at <40 and >40 weeks’ gestation was estimated. Results: The study population of 3,703 singleton pregnancies included 38 (1.0%) with PE at <40 weeks’ gestation and 22 (0.6%) with PE at >40 weeks. Using a risk cut-off for PE
at <4 weeks of 1 in 50 to define the high-risk group and a risk cut-off of <1 in 100 for PE at <42 weeks’ gestation to define the low-risk group, the proportion of the population
stratified into high-, intermediate- and low-risk was about 12.7%, 28.8% and 58.5%, respectively. The high-risk group contained 92% of pregnancies with PE at <40 weeks’ gestation and 73% of those with PE at >40 weeks. The intermediate-risk group contained a further 27% of women with PE at >40 weeks. In the low-risk group, none of the women developed PE at <40 or >40 weeks’ gestation. Conclusion: The study presents risk stratification of PE by the combined test at 35-37 weeks aiming to identify a high-risk group in need of intensive monitoring from the time of
the initial assessment and up to 40 weeks’ gestation, an intermediate-risk group in need of reassessment at 40 weeks’ gestation and a low-risk group which can be reassured that
they are unlikely to develop PE. |
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| References | 1. Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011; 29:
183–196.
2. Roberge S, Nicolaides K, Demers S, Villa P, Bujold E. Prevention of perinatal death
and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound
Obstet Gynecol 2013; 41: 491–499.
3. Costantine MM, Cleary K, Hebert MF, Ahmed MS, Brown LM, Ren Z, Easterling
TR,HaasDM,HanelineLS,CaritisSN,VenkataramananR,WestH,D’AltonM,
Hankins G. Safety and pharmacokinetics of pravastatin used for the prevention of
preeclampsia in high-risk pregnant women: a pilot randomized controlled trial. Am
J Obstet Gynecol 2016; 214: 720.e1–17.
4. Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ,
van den Berg PP, de Boer K, Burggraaff JM, Bloemenkamp KW, Drogtrop AP,
Franx A, de Groot CJ, Huisjes AJ, Kwee A, van Loon AJ, Lub A, Papatsonis DN,
van der Post JA, Roumen FJ, Scheepers HC, Willekes C, Mol BW, van Pampus
MG; HYPITAT study group. Induction of labour versus expectant monitoring for
gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT):
a multicentre, open-label randomised controlled trial. Lancet 2009; 374: 979–988.
5. Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks
model in screening for preeclampsia by maternal characteristics and medical history.
Am J Obstet Gynecol 2015; 213: 62.e1–10.
6. Andrietti S, Silva M, Wright A, Wright D, Nicolaides KH. Competing-risks model
in screening for pre-eclampsia by maternal factors and biomarkers at 35 –37 weeks’
gestation. Ultrasound Obstet Gynecol 2016; 48:72–79
7. O’Gorman N, Wright D, Syngelaki A, Akolekar R, Wright A, Poon LC, Nicolaides
KH. Competing risks model in screening for preeclampsia by maternal factors and
biomarkers at 11-13 weeks’ gestation. Am J Obstet Gynecol 2016; 214: 103.e1–12.
8. Gallo DM, Wright D, Casanova C, Campanero M, Nicolaides KH. Competing risks
model in screening for preeclampsia by maternal factors and biomarkers at 19–24
weeks’ gestation. Am J Obstet Gynecol 2016; 214: 619e1.
9. Tsiakkas A, Saiid Y, Wright A, Wright D, Nicolaides KH. Competing risks model
in screening for preeclampsia by maternal factors and biomarkers at 30–34 weeks’
gestation. Am J Obstet Gynecol 2016; 215: 87.e1–17.
10. Albaiges G, Missfelder-Lobos H, Lees C, Parra M, Nicolaides KH. One-stage
screening for pregnancy complications by color Doppler assessment of the uterine
arteries at 23 weeks’ gestation. Obstet Gynecol 2000; 96: 559–564.
11. Poon LC, Zymeri NA, Zamprakou A, Syngelaki A, Nicolaides KH. Protocol for
measurement of mean arterial pressure at 11-13 weeks’ gestation. Fetal Diagn Ther
2012; 31: 42–48.
12. Robinson HP, Fleming JE. A critical evaluation of sonar crown rump length
measurements. Br J Obstet Gynaecol 1975; 82: 702–710.
13. Snijders RJ, Nicolaides KH. Fetal biometry at 14–40 weeks’ gestation. Ultrasound
Obstet Gynecol 1994; 4: 34–48.
14. Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The
classification and diagnosis of the hypertensive disorders of pregnancy: Statement
from the international society for the study of hypertension in pregnancy (ISSHP).
Hypertens Pregnancy 2001; 20:IX–XIV.
15. Wright A, Wright D, Ispas A, Poon LC, Nicolaides KH. Mean arterial pressure in the
three trimesters of pregnancy: effects of maternal characteristics and medical history.
Ultrasound Obstet Gynecol 2015; 45: 698–706.
16. Tayyar A, Guerra L, Wright A, Wright D, Nicolaides KH. Uterine artery pulsatility
index in the three trimesters of pregnancy: effects of maternal characteristics and
medical history. Ultrasound Obstet Gynecol 2015; 45: 689–697.
17. Tsiakkas A, Duvdevani N, Wright A, Wright D, Nicolaides KH. Serum placental
growth factor in the three trimesters of pregnancy: effects of maternal characteristics
and medical history. Ultrasound Obstet Gynecol 2015; 45: 591–598.
18. Tsiakkas A, Duvdevani N, Wright A, Wright D, Nicolaides KH. Serum soluble
fms-like tyrosine kinase-1 in the three trimesters of pregnancy: effects of
maternal characteristics and medical history. Ultrasound Obstet Gynecol 2015; 45:
584–590.
19. Development Core Team. R. A language and environment for statistical computing.
R Foundation for Statistical Computing, Vienna, Austria. 2011; ISBN https://doi
.org/3-900051-07-0, http://www.R-project.org/.
20. Wright D, Dragan I, Syngelaki A, Akolekar R, Nicolaides KH. Proposed clinical
management of pregnancies after combined screening for pre-eclampsia at 30–34
weeks’ gestation. Ultrasound Obstet Gynecol 2017; 49: 194–200.
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