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The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo
Published on: August 2, 2017
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Long-Term Predictors of Gestational Hypertension: Placental Growth Factor, Pregnancy-Associated Plasma Protein-A and
Saswati Sanyal Choudhury1, Bhanita Deka1, Madhurima Bora2
1Department of Obstetrics and Gynaecology, Gauhati Medical College and Hospital, Guwahati, Kamrup (Metro), Assam 781032 India.
Journal of Obstetrics and Gynaecology of India
|May 6, 2024
Summary
Combining biophysical and biochemical markers offers the best prediction for pregnancy-induced hypertension (PIH). This approach can significantly improve early detection and management of PIH, reducing maternal mortality.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Cardiovascular Physiology in Pregnancy
Background:
- Hypertensive disorders are a leading cause of direct maternal mortality globally, particularly in developing nations.
- Pregnancy-induced hypertension (PIH) poses significant risks to both mother and fetus.
- Early and accurate prediction of PIH is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To compare the efficacy of biophysical markers (mean arterial pressure and uterine artery Doppler) versus biochemical markers (serum-free β HCG, PAPP-A, PlGF) versus a combination of all markers.
- To identify the optimal screening strategy for predicting pregnancy-induced hypertension (PIH) in primigravidae.
- To assess the long-term predictive value of these markers for PIH development.
Main Methods:
- A prospective, observational cohort study involving 97 primigravidae.
- Recruitment and assessment of biophysical and biochemical markers at 11 to 13+6 weeks gestation.
- Follow-up assessments at 32-34 weeks and before delivery to document PIH development and adverse outcomes.
Main Results:
- The combined group (Group C) demonstrated the highest sensitivity (97.37%) and specificity (38.98%) for predicting gestational hypertension.
- A statistically significant correlation was found between combined markers and PIH development (p < 0.0001).
- Placental growth factor (PlGF) levels showed a mild negative correlation with PIH severity (p=0.0382).
Conclusions:
- The combination of biophysical and biochemical markers is the most effective screening test for predicting gestational hypertension.
- Integrating mean arterial pressure (MAP) and uterine artery Doppler (UAD) is feasible in most hospital settings.
- Low-cost biochemical test kits, potentially supported by programs like JSSK, could reduce maternal mortality by preventing gestational hypertension.
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