Effectiveness of Different Algorithms and Cut-off Value in Preeclampsia First Trimester Screening

Area of Science:

• Maternal-fetal medicine
• Obstetrics and Gynecology
• Clinical screening protocols

Background:

• Early-onset pre-eclampsia (eo-PE) poses significant risks to maternal and fetal health.
• Accurate and efficient screening is crucial for timely intervention and improved pregnancy outcomes.
• Existing screening algorithms vary in their effectiveness and resource utilization.

Purpose of the Study:

• To evaluate the performance of different algorithms in identifying women at increased risk for eo-PE.
• To compare the diagnostic accuracy of algorithms incorporating placental growth factor (PlGF) versus those that do not.
• To assess the implications of screening strategies on treatment decisions, such as acetylsalicylic acid administration.

Main Methods:

• Comparative analysis of four distinct algorithms for eo-PE risk assessment.
• Evaluation of algorithm performance based on identified high-risk pregnancies.
• Assessment of potential overtreatment with acetylsalicylic acid in low-risk groups based on screening results.

Main Results:

• Algorithm 2 identified 96% of women at increased risk for eo-PE, demonstrating superior performance compared to algorithms 3 (72%) and 4 (69%) at a cut-off point >1:150.
• A screening approach excluding PlGF measurement could lead to 21-29% of low-risk women being unnecessarily treated with acetylsalicylic acid.
• Algorithm 1 identified 86 women at increased risk, with Algorithm 2 capturing the vast majority of these cases.

Conclusions:

• Comprehensive screening for eo-PE is essential for optimal maternal healthcare.
• Algorithm 2 emerges as a highly effective method for identifying high-risk pregnancies.
• Algorithms relying solely on MAP and UtPI may lead to unnecessary interventions and potential complications.