Implementation of routine first trimester combined screening for pre-eclampsia: a clinical effectiveness study.

Area of Science:

• Maternal-Fetal Medicine
• Obstetrics
• Public Health

Background:

• Pre-eclampsia poses significant risks to both mother and fetus.
• Early detection and intervention are crucial for managing pre-eclampsia.
• Existing screening methods have limitations in public healthcare settings.

Purpose of the Study:

• To evaluate the clinical effectiveness of the first trimester combined screening program for pre-eclampsia.
• To assess the feasibility of implementing this screening in a public healthcare setting.
• To compare the Fetal Medical Foundation (FMF) algorithm with existing National Institute for Health and Care Excellence (NICE) guidelines.

Main Methods:

• Retrospective cohort study involving 7720 women screened by NICE guidelines and 4841 by the FMF algorithm.
• The FMF algorithm integrated maternal risk factors, blood pressure, PAPP-A, and uterine artery Doppler.
• High-risk criteria were defined by NICE or an FMF algorithm risk of ≥1:50 for preterm pre-eclampsia.

Main Results:

• The FMF screening significantly reduced the screen-positive rate (16.1% to 8.2%) and increased targeted aspirin use (28.9% to 99.0%).
• Receiver operating characteristic (ROC) analysis showed excellent discrimination for preterm pre-eclampsia (AUC = 0.846).
• Interrupted time series analysis revealed a 21-month relative effect reduction of 80% for preterm and 89% for early pre-eclampsia.

Conclusions:

• First trimester combined screening for pre-eclampsia is feasible and effective in public healthcare.
• This approach leads to risk de-escalation, doubled pre-eclampsia detection, and near-total physician compliance with aspirin use.
• Implementation significantly reduces the prevalence of preterm pre-eclampsia.