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- Skrastad, R. B., et al.
(author)
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Risk assessment for preeclampsia in nulliparous women at 11-13weeks gestational age: prospective evaluation of two algorithms
- 2015
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In: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 122:13, s. 1781-1788
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Journal article (peer-reviewed)abstract
- ObjectiveTo evaluate two algorithms for prediction of preeclampsia in a population of nulliparous women in Norway. DesignProspective screening study. SettingNational Centre for Fetal Medicine in Trondheim, Norway. PopulationFive hundred and forty-one nulliparous women. MethodsThe women were examined between 11(+0) and 13(+6)weeks with interviews for maternal characteristics and measurements of mean arterial pressure, uterine artery pulsatility index, pregnancy-associated plasma protein A and placental growth factor. The First Trimester Screening Program version 2.8 by The Fetal Medicine Foundation (FMF) was compared with the Preeclampsia Predictor TM version 1 revision 2 by Perkin Elmer (PREDICTOR). Main outcome measuresPrediction of preeclampsia requiring delivery before 37weeks, before 42weeks and late preeclampsia (delivery after 34weeks). ResultsThe performance of the two algorithms was similar, but quite poor, for prediction of preeclampsia requiring delivery before 42weeks with an area under the curve of 0.77 (0.67-0.87) and sensitivity 40% (95% CI 19.1-63.9) at a fixed 10% false positive rate for FMF and 0.74 (0.63-0.84) and sensitivity 30% (95% CI 11.9-54.3) at a fixed 10% false positive rate for PREDICTOR. The FMF algorithm for preeclampsia requiring delivery <37weeks had an area under the curve of 0.94 (0.86-1.0) and sensitivity of 80% (95% CI 28.4-99.5) at a 10% fixed false positive rate. ConclusionsFetal Medicine Foundation and PREDICTOR algorithms had similar and only modest performance in predicting preeclampsia. The results indicate that the FMF algorithm is suitable for prediction of preterm preeclampsia.
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| 2. |
- Skrastad, Ragnhild B., et al.
(author)
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A prospective study of screening for hypertensive disorders of pregnancy at 11-13 weeks in a Scandinavian population
- 2014
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In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 93:12, s. 1238-1247
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Journal article (peer-reviewed)abstract
- ObjectiveTo investigate the prediction of preeclampsia and gestational hypertension using maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI), pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF) at gestational weeks 11-13 in a Scandinavian population with a medium to high prior risk for developing hypertensive disorders of pregnancy. DesignProspective screening study. SettingNational Center for Fetal Medicine, Trondheim, Norway. Population579 women who were nulliparous or had a previous history of preeclampsia or gestational hypertension. MethodsWomen were examined between 11(+0) and 13(+6)weeks, with interviews for maternal characteristics and measurements of MAP, UtAPI, PAPP-A and PlGF. The tests were evaluated separately and in combined models with receiver operating characteristics (ROC) curves. Main outcome measuresPrediction of preeclampsia, severe preeclampsia and gestational hypertension. ResultsThe best model for severe preeclampsia (MAP+UtAPI+PlGF+PAPP-A) achieved an area under the ROC curve of 0.866 [95% confidence interval (95% CI) 0.756-0.976]. The best models for preeclampsia (MAP+UtAPI+age) achieved 0.738 (0.634-0.841), gestational hypertension (MAP) 0.820 (0.727-0.913) and hypertensive disorders in pregnancy overall (MAP+PlGF+age) 0.783 (0.709-0.856). Using the best model we could identify 61.5% (95% CI 31.6-86.1) of severe preeclampsia, 38.5% (95% CI 20.2-59.4) of preeclampsia and 42.9% (95% CI 21.8-66) of gestational hypertension at a fixed 10% false-positive rate. ConclusionsMaternal characteristics, MAP, UtAPI, PAPP-A and PlGF showed limited value as screening tests. Further research on biochemical and biophysical tests and algorithms combining these parameters is needed before first trimester screening for hypertensive disorders of pregnancy is included in antenatal care in Scandinavia.
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