Third-Trimester Screening for Preeclampsia in Twins: Comparative Performance of Fetal Medicine Foundation Algorithm,...

Area of Science:

• Maternal-Fetal Medicine
• Diagnostic Screening
• Pregnancy Complications

Background:

• Preeclampsia is a significant complication of twin pregnancies.
• Effective third-trimester screening is crucial for timely intervention.
• Comparing existing screening methods is essential for clinical practice.

Purpose of the Study:

• To compare the efficacy of three third-trimester preeclampsia screening methods in twin pregnancies.
• To evaluate the Fetal Medicine Foundation (FMF) multi-marker algorithm, Roche triage, and Quidel triage.
• To determine detection rates, false-positive rates, and predictive values of each method.

Main Methods:

• A cohort of women with twin pregnancies was enrolled early in gestation.
• Blood samples were collected at multiple time points, including the third trimester.
• Preeclampsia screening was performed using the FMF algorithm, Roche triage (sFLT-1/PlGF ratio), and Quidel triage (PlGF) on fresh and stored samples.

Main Results:

• The FMF algorithm achieved a 79.2% detection rate (DR) with a 5.3% false-positive rate (FPR).
• Roche triage showed a 62.5% DR and 22.1% FPR (fresh samples).
• The FMF algorithm demonstrated a statistically significant higher area under the receiver operating characteristic curve (AUROC) of 0.91 compared to Roche (0.74) and Quidel (0.75) triages.

Conclusions:

• The FMF multi-marker algorithm is more effective for third-trimester preeclampsia screening in twin pregnancies than Roche or Quidel triages.
• The choice of screening method should consider local resources and clinical guidelines.
• This study provides insights into the strengths and limitations of each screening approach.