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The Effectiveness of a First-Trimester Combined Screening Model for Risk Stratification of Preeclampsia (PE)
Narayanasamy Saranya1, Vellathussery Chakkalakkoombil Sunitha2, Bobby Zachariah3
1Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Aim:
To ascertain the effectiveness of a first-trimester combined screening model for risk stratification of preeclampsia (PE) in a south Indian population.
Methods:
One hundred and sixty pregnant women were screened at 11-14 gestation weeks with routine antenatal ultrasound, mean uterine artery pulsatility index (UtA PI), mean arterial blood pressure (MAP), and serum placental growth factor (PlGF) assessments. Sensitivity, specificity, area under the receiver operator characteristic (AUC) curves, and diagnostic accuracy were ascertained for 1 in 50, 1 in 100, and 1 in 150 cutoff criteria.
Results:
PE and gestational hypertension developed in 18 (11.6%, 95% CI: 7.47-19.67) and 10 (6.5%, 95% CI: 3.54-11.74) screened women, respectively. The first-trimester combined screening model identified 26 (16.77%), 34 (21.94%), and 38 (24.52%) screen-positive women using a 1 in 50, 1 in 100, and 1 in 150 cut-offs, respectively and had an AUC of 0.85 (95% CI: 0.76, 0.93). The detection rates, AUC, and odds ratio were higher with the 1 in 150 cut-off criteria than the 1 in 100 or 1 in 50 cut-off, but there was a slight decrease in the specificity and diagnostic accuracy.
Conclusion:
The first-trimester combined screening model at 11-14 weeks differentiated pregnant women at high risk for preterm PE in this population. A risk stratification cutoff of 1 in 150 had a better AUC than a 1 in 100 or 1 in 50 cutoff.
