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Routine first trimester combined screening for preterm preeclampsia in Australia: A multicenter clinical
Daniel L Rolnik1, Roshan J Selvaratnam1,2, Dagmar Wertaschnigg3
1Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Victoria, Australia.
Summary
First trimester screening for preterm preeclampsia in Australia identified high-risk pregnancies. This approach helps tailor antenatal care, improving outcomes for both high-risk and low-risk women.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Public Health
Background:
- Preeclampsia, particularly preterm preeclampsia, is a significant cause of maternal and neonatal morbidity.
- Early identification of women at risk for preterm preeclampsia is crucial for timely intervention and improved pregnancy outcomes.
- Current screening methods in Australia vary, necessitating an evaluation of combined screening effectiveness.
Purpose of the Study:
- To evaluate the effectiveness of first-trimester combined screening for preterm preeclampsia in Australian singleton pregnancies.
- To compare pregnancy outcomes between women undergoing combined screening and those receiving standard care.
- To assess the performance of the Fetal Medicine Foundation algorithm in identifying women at high risk for preterm preeclampsia.
Main Methods:
- A comparative study involving singleton pregnancies in Melbourne and Sydney, Australia (2014-2017).
- Comparison of outcomes between women who underwent first-trimester combined screening and those who received standard antenatal care.
- Analysis of primary outcomes including preterm preeclampsia incidence and screening performance metrics, using risk ratios and 95% confidence intervals.
Main Results:
- Over 331,000 women were included; 29,618 underwent combined screening and 301,566 received standard care.
- Women in the combined screening group had lower rates of preeclampsia, preterm birth, small for gestational age neonates, and low Apgar scores.
- High-risk women (≥1:100) had a threefold increased risk of preterm preeclampsia (2.1% vs 0.7%), while low-risk women (<1:100) had significantly lower rates (0.2% vs 0.7%).
- The screening detected 65.2% of all preterm preeclampsia cases, with improved performance noted after treatment effect adjustment.
Conclusions:
- First-trimester combined screening effectively identifies women at high risk for preterm preeclampsia in clinical practice.
- The screening approach allows for the stratification of pregnant women, enabling less intensive antenatal care for low-risk individuals.
- This strategy has the potential to optimize resource allocation and improve overall maternal and neonatal outcomes in Australia.
