Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 30-34 weeks' gestation

Journal article


Wright, D., Dragan, I., Syngelaki, A., Akolekar, R. and Nicolaides, K.H. 2017. Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 30-34 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (2), pp. 194-200. https://doi.org/10.1002/uog.17309
AuthorsWright, D., Dragan, I., Syngelaki, A., Akolekar, R. and Nicolaides, K.H.
Abstract

Objective: To estimate the patient-specific risk of preeclampsia (PE) at 30-34 weeks’ gestation by a combination of maternal characteristics and medical history with multiple of the median (MoM) values of mean arterial pressure, uterine artery pulsatility index, serum the median (MoM) values of mean arterial pressure, uterine artery pulsatility index, serum placental growth factor and serum soluble fmsm-like tyrosine kinase-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 30-34 weeks as part of routine pregnancy care. Patient-specific risks of delivery with PE at <4 weeks from assessment and at <40 weeks’ of delivery with PE at <4 weeks from assessment and at <40 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 <4 weeks and delivery with PE from four weeks after assessment and up to 40 weeks’ gestation (PE 4w-40GW) was estimated.

Results: The study population of 8,128 singleton pregnancies included 234 (2.9%) that subsequently developed PE. Using a risk cut-off for PE at <4 weeks of 1 in 50 and a risk cut-off of 1 in 150 for PE at <40 weeks’ gestation the proportion of the population stratified into high-, intermediate- and low-risk was about 3%, 26% and 71%, respectively. The high-risk group contained 90% of pregnancies with PE at at <4 weeks and 40% of those with PE at 4w-40GW. The intermediate-risk group contained a further 49% of women with PE at 4w-40GW. In the low-risk group, none of the women developed PE at <4 weeks and only 0.3% developed PE at 4w-40GW.

Conclusion: The study presents risk stratification of PE by the combined test at 30-34 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 and an intermediate-risk group, in need of monitoring starting from four weeks after the initial assessment and up to 40 weeks’ gestation. All pregnancies would need to be reassessed at 40 weeks’ gestation.

KeywordsPlacental growth factor; Soluble fms-like tyrosine kinase-1; Mean arterial pressure; Uterine artery pulsatility index; Preeclampsia; Pyramid of antenatal care
Year2017
JournalUltrasound in Obstetrics and Gynecology
Journal citation49 (2), pp. 194-200
PublisherWiley
ISSN1469-0705
Digital Object Identifier (DOI)https://doi.org/10.1002/uog.17309
Official URLhttp://doi.org/10.1002/uog.17309
Related URLhttps://pubmed.ncbi.nlm.nih.gov/27671544/
Publication dates
Online27 Sep 2016
Publication process dates
Accepted15 Sep 2016
Deposited10 Jun 2020
Accepted author manuscript
Output statusPublished
References

1. 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.
2. 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
pre-eclampsia in high-risk pregnant women: a pilot randomized controlled trial. Am
J Obstet Gynecol 2016; 214: 720.e1–17
3. 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.
4. Tsiakkas A, Saiid Y, Wright A, Wright D, Nicolaides KH. Competing risks model
in screening for pre-eclampsia by maternal factors and biomarkers at 30–34 weeks’
gestation. Am J Obstet Gynecol 2016; 215: 87.e1–17.
5. 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.
6. 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.
7. Robinson HP, Fleming JE. A critical evaluation of sonar crown rump length
measurements. BrJObstetGynaecol1975; 82: 702–710.
8. Snijders RJ, Nicolaides KH. Fetal biometry at 14– 40 weeks’ gestation. Ultrasound
Obstet Gynecol 1994; 4: 34–48.
9. 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.
10. Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks
model in screening for pre-eclampsia by maternal characteristics and medical history.
Am J Obstet Gynecol 2015; 213: 62.e1–10.
11. Wright D, Akolekar R, Syngelaki A, Poon LC, Nicolaides KH. A competing risks
model in early screening for pre-eclampsia. Fetal Diagn Ther 2012; 32: 171–178.
12. 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.
13. 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.
14. 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.
15. 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.
16. R Development Core Team. R. A language and environment for statistical
computing. R Foundation for Statistical Computing, Vienna, Austria. 2011; ISBN
3-900051-07-0, http://www.R-project.org/.
17. Li H, Gudnason H, Olofsson P, Dubiel M, Gudmundsson S. Increased uterine artery
vascular impedance is related to adverse outcome of pregnancy but is present in only
one third of late third-trimester pre-eclamptic women. Ultrasound Obstet Gynecol
2005; 25: 459–463.
18. Ghi T, Youssef A, Piva M, Contro E, Segata M, Guasina F, Gabrielli S, Rizzo N,
Pelusi G, Pilu G. The prognostic role of uterine artery Doppler studies in patients
with late-onset pre-eclampsia. Am J Obstet Gynecol 2009; 201: 36.e1–5.
19. Chaiworapongsa T, Romero R, Savasan ZA, Kusanovic JP, Ogge G, Soto E,
Dong Z, Tarca A, Gaurav B, Hassan SS. Maternal plasma concentrations of
angiogenic/anti-angiogenic factors are of prognostic value in patients presenting
to the obstetrical triage area with the suspicion of pre-eclampsia. J Matern Fetal
Neonatal Med 2011; 24: 1187–1207.
20. Verlohren S, Herraiz I, Lapaire O, Schlembach D, Moertl M, Zeisler H, Calda P,
Holzgreve W, Galindo A, Engels T, Denk B, Stepan H. The sFlt-1/PlGF ratio in
different types of hypertensive pregnancy disorders and its prognostic potential in
preeclamptic patients. Am J Obstet Gynecol 2012; 206: 58.e1–8.
21. Rana S, Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, Lim KH,
Wenger JB, Thadhani R, Karumanchi SA. Angiogenic factors and the risk of adverse
outcomes in women with suspected pre-eclampsia. Circulation 2012; 125: 911–919.
22. Sibiude J, Guibourdenche J, Dionne MD, Le Ray C, Anselem O, Serreau R, Goffinet
F, Tsatsaris V. Placental growth factor for the prediction of adverse outcomes in
patients with suspected pre-eclampsia or intrauterine growth restriction. PLoS One
2012; 7: e50208.
23. Ohkuchi A, Hirashima C, Takahashi K, Suzuki H, Matsubara S, Suzuki M. Onset
threshold of the plasma levels of soluble fms-like tyrosine kinase-1/placental growth
factor ratio for predicting the imminent onset of pre-eclampsia within 4 weeks after
blood sampling at 19-31 weeks of gestation. Hypertens Res 2013; 36: 1073–1080.
24. Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennstr
¨
om M, Olovsson M,
Brennecke SP, Stepan H, Allegranza D, Dilba P, Schoedl M, Hund M, Verlohren S.
Predictive value of the sFlt-1:PlGF ratio in women with suspected pre-eclampsia. N
Engl J Med 2016; 374: 13–22.
25. Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011; 29:
183–196.

Permalink -

https://repository.canterbury.ac.uk/item/8vq34/proposed-clinical-management-of-pregnancies-after-combined-screening-for-pre-eclampsia-at-30-34-weeks-gestation

  • 14
    total views
  • 0
    total downloads
  • 1
    views this month
  • 0
    downloads this month

Export as

Related outputs

Predicting the risk to develop preeclampsia in the first trimester combining promoter variant -98A/C of LGALS13 (placental protein 13), Black ethnicity, previous preeclampsia, obesity, and maternal age
Madar-Shapiro, L., Karady, I., Trahtenherts, A., Syngelaki, A., Akolekar, R., Poon, L., Cohen, R., Sharabi-Nov, A., Huppertz, B., Sammar, M., Juhasz, K., Than, N.G., Papp, Z., Romero, R., Nicolaides, K.H. and Meiri, H. 2018. Predicting the risk to develop preeclampsia in the first trimester combining promoter variant -98A/C of LGALS13 (placental protein 13), Black ethnicity, previous preeclampsia, obesity, and maternal age. Fetal Diagnosis & Therapy. 43 (4), pp. 250-265. https://doi.org/10.1159/000477933
Risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review of the literature
Beta, J., Lesmes-Heredia, C., Bedetti, C. and Akolekar, R. 2018. Risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review of the literature. Minerva Ginecologica. 70 (2), pp. 215-219. https://doi.org/10.23736/S0026-4784.17.04178-8
Fetal major cardiac defects and placental dysfunction at 11-13 weeks' gestation
Fantasia, I., Kasapoglu, D., Kasapoglu, T., Syngelaki, A., Akolekar, R. and Nicolaides, K. H. 2018. Fetal major cardiac defects and placental dysfunction at 11-13 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 51 (2), pp. 194-198. https://doi.org/10.1002/uog.18839
ASPRE trial: incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm
Allen, A., Poon, L. C., Rolnik, D. L., Tan, M. Y., Delgado, J. L., Tsokaki, T., Akolekar, R., Singh, M., Andrade, W., Efeturk, T., Jani, J. C., Plasencia, W., Papaioannou, G., Blazquez, A. R., Carbone, I. F., Wright, D. and Nicolaides, K. H. 2018. ASPRE trial: incidence of preterm pre-eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm. Ultrasound in Obstetrics and Gynecology. 51 (6), pp. 738-742. https://doi.org/10.1002/uog.19019
Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE
Tan, M. Y., Wright, D., Syngelaki, A., Akolekar, R., Cicero, S., Janga, D., Singh, M., Greco, E., Wright, A., Maclagan, K., Poon, L. C. and Nicolaides, K. H. 2018. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE. Ultrasound in Obstetrics and Gynecology. 51 (6), pp. 743-750.
Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models
Hammami, A., Mazer Zumaeta, A., Syngelaki, A., Akolekar, R. and Nicolaides, K. H. 2018. Ultrasonographic estimation of fetal weight: development of new model and assessment of performance of previous models. Ultrasound in Obstetrics and Gynecology. 52 (1), pp. 35-43. https://doi.org/10.1002/uog.19066
Fetal Medicine Foundation fetal and neonatal population weight charts
Nicolaides, K. H., Wright, D., Syngelaki, A., Wright, A. and Akolekar, R. 2018. Fetal Medicine Foundation fetal and neonatal population weight charts. Ultrasound in Obstetrics and Gynecology. 52 (1), pp. 44-51. https://doi.org/10.1002/uog.19073
Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation
Tan, M.Y., Syngelaki, A., Poon, L.C., Rolnik, D.L., O'Gorman, N., Delgado, J.L., Akolekar, R., Konstantinidou, L., Tsavdaridou, M., Galeva, S., Ajdacka, U., Molina, F.S., Persico, N., Jani, J.C., Plasencia, W., Greco, E., Papaioannou, G., Wright, A., Wright, D. and Nicolaides, K.H. 2018. Screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 52 (2), pp. 186-195. https://doi.org/10.1002/uog.19112
Reference ranges for the size of the fetal cardiac outflow tracts from 13 to 36 weeks gestation: a single-center study of over 7000 cases
Vigneswaran, T.V., Akolekar, R., Syngelaki, A., Charakida, M., Allan, L.D., Nicolaides, K.H., Zidere, V. and Simpson, J.M. 2018. Reference ranges for the size of the fetal cardiac outflow tracts from 13 to 36 weeks gestation: a single-center study of over 7000 cases. Circulation Cardiovascular Imaging. 11 (7), p. e007575. https://doi.org/10.1161/CIRCIMAGING.118.007575
Comparison of screening for pre-eclampsia at 31-34 weeks' gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF
Tan, M.Y., Wright, D., Koutoulas, L., Akolekar, R. and Nicolaides, K.H. 2017. Comparison of screening for pre-eclampsia at 31-34 weeks' gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF. Ultrasound in Obstetrics and Gynecology. 49 (2), pp. 201-208. https://doi.org/10.1002/uog.17307
Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation
O'Gorman, N., Wright, D., Poon, L.C., Rolnik, D.L., Syngelaki, A., Wright, A., Akolekar, R., Cicero, S., Janga, D., Jani, J., Molina, F.S., de Paco Matallana, C., Papantoniou, N., Persico, N., Plasencia, W., Singh, M. and Nicolaides, K.H. 2017. Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 49 (6), pp. 751-755. https://doi.org/10.1002/uog.17399
Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 35-37 weeks' gestation
Panaitescu, A.M., Wright, D., Militello, A., Akolekar, R. and Nicolaides, K.H. 2017. Proposed clinical management of pregnancies after combined screening for pre-eclampsia at 35-37 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 50 (3), pp. 383-387. https://doi.org/10.1002/uog.17419
Chronic hypertension and adverse pregnancy outcome: a cohort study
Panaitescu, A.M., Syngelaki, A., Prodan, N., Akolekar, R. and Nicolaides, K.H. 2017. Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound in Obstetrics and Gynecology. 50 (2), pp. 228-235. https://doi.org/10.1002/uog.17493
Impaired placentation in women with chronic hypertension who develop pre-eclampsia
Panaitescu, A.M., Akolekar, R., Kametas, N., Syngelaki, A. and Nicolaides, K.H. 2017. Impaired placentation in women with chronic hypertension who develop pre-eclampsia. Ultrasound in Obstetrics and Gynecology. 50 (4), pp. 496-500. https://doi.org/10.1002/uog.17517
Association of chronic hypertension with birth of small-for-gestational-age neonate
Panaitescu, A.M., Baschat, A.A., Akolekar, R., Syngelaki, A. and Nicolaides, K.H. 2017. Association of chronic hypertension with birth of small-for-gestational-age neonate. Ultrasound in Obstetrics and Gynecology. 50 (3), pp. 361-366. https://doi.org/10.1002/uog.17553
Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia
Rolnik, D.L., Wright, D., Poon, L.C., O'Gorman, N., Syngelaki, A., de Paco Matallana, C., Akolekar, R., Cicero, S., Janga, D., Singh, M., Molina, F.S., Persico, N., Jani, J.C., Plasencia, W., Papaioannou, G., Tenenbaum-Gavish, K., Meiri, H., Gizurarson, S., Maclagan, K. and Nicolaides, K.H. 2017. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. The New England Journal of Medicine. 377 (7), pp. 613-622. https://doi.org/10.1056/NEJMoa1704559
Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history.
Poon, L.C., Wright, D., Rolnik, D.L., Syngelaki, A., Delgado, J.L., Tsokaki, T., Leipold, G., Akolekar, R., Shearing, S., De Stefani, L., Jani, J.C., Plasencia, W., Evangelinakis, N., Gonzalez-Vanegas, O., Persico, N., Nicolaides, K.H. and Allen, A. 2017. Aspirin for evidence-based preeclampsia prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history. American Journal of Obstetrics & Gynecology. 217 (5), pp. 585.e1- 5.. https://doi.org/10.1016/j.ajog.2017.07.038
Association between insulin resistance and preeclampsia in obese non-diabetic women receiving metformin
Balani, J., Hyer, S., Syngelaki, A., Akolekar, R., Nicolaides, K. H., Johnson, A. and Shehata, H. 2017. Association between insulin resistance and preeclampsia in obese non-diabetic women receiving metformin. Obstetric Medicine. 10, pp. 170-173. https://doi.org/10.1177/1753495X17725465