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First trimester preeclampsia screening and prediction.

Piya Chaemsaithong1, Daljit Singh Sahota1, Liona C Poon1

  • 1Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.

American Journal of Obstetrics and Gynecology
|July 20, 2020
PubMed
Summary
This summary is machine-generated.

First-trimester screening for preeclampsia using the Fetal Medicine Foundation (FMF) triple test significantly improves detection rates. This method, combined with low-dose aspirin, effectively reduces preterm preeclampsia incidence.

Keywords:
ASPRECUSUMFGRFMFFetal Medicine FoundationIUGRNNSNNTPLGFUtA-PIabruptionadverse pregnancy outcomealgorithmaspirinblood pressurecompeting riskfetal growth restrictionfirst trimesterhypertensionmean arterial pressuremorbiditymortalitynumber needed to screennumber needed to treatperinatalplacental growth factorplacental insufficiencypredictionpreeclampsiapregnancypregnancy complicationsprematuritypretermpreventionprophylaxispulsatility indexquality assessmentquality assuranceresistant indexrisk factorsafetystillbirthtarget plotuterine arteryvalidation

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Area of Science:

  • Maternal-Fetal Medicine
  • Obstetrics
  • Biomarker Discovery

Background:

  • Preeclampsia, a leading cause of maternal and perinatal mortality, poses higher risks when presenting as early-onset disease requiring preterm delivery.
  • Current screening methods based on maternal risk factors (ACOG, NICE) demonstrate suboptimal performance in detecting preeclampsia.
  • Timely intervention, such as low-dose aspirin initiated before 16 weeks' gestation, is crucial for reducing preterm preeclampsia rates.

Purpose of the Study:

  • To evaluate the efficacy of first-trimester preeclampsia screening methods.
  • To compare the performance of the Fetal Medicine Foundation (FMF) triple test against traditional risk factor-based screening.
  • To review quality assessment protocols for biomarker measurements in preeclampsia screening.

Main Methods:

  • Review of existing literature on first-trimester preeclampsia screening methods and professional organization recommendations.
  • Analysis of the Fetal Medicine Foundation (FMF) triple test, incorporating maternal factors, mean arterial pressure, uterine artery pulsatility index, and placental growth factor.
  • Examination of quality control tools (cumulative sum, target plot) for biomarker measurements.

Main Results:

  • The FMF triple test demonstrates superior performance with detection rates of 90% for early and 75% for preterm preeclampsia at a 10% false-positive rate.
  • Screening with the FMF model followed by low-dose aspirin reduced preterm preeclampsia by 62%, with a number needed to screen of 250.
  • Traditional risk factor-based screening (NICE, ACOG) shows significantly lower detection rates.

Conclusions:

  • The FMF triple test offers a validated and effective approach for first-trimester preeclampsia screening, outperforming traditional methods.
  • Standardized protocols and rigorous quality assessment of biomarker measurements are essential for maintaining optimal screening performance.
  • Implementing the FMF triple test can lead to a significant reduction in preterm preeclampsia incidence through timely therapeutic interventions.