Combined screening for early and late pre-eclampsia and intrauterine growth restriction by maternal history, uterine artery Doppler, mean arterial pressure and biochemical markers

被引:14
|
作者
Litwinska, Ewelina [1 ]
Litwinska, Magdalena [2 ]
Oszukowski, Przemyslaw [1 ]
Szaflik, Krzysztof [2 ]
Kaczmarek, Piotr [3 ]
机构
[1] Polish Mothers Mem Hosp, Res Inst, Perinatol & Gynecol Dept, Lodz, Poland
[2] Polish Mothers Mem Hosp, Res Inst, Dept Gynecol Fertil & Fetal Therapy, Lodz, Poland
[3] Polish Mothers Mem Hosp, Res Inst, Dept Operat Gynecol & Oncol Gynecol, Lodz, Poland
来源
ADVANCES IN CLINICAL AND EXPERIMENTAL MEDICINE | 2017年 / 26卷 / 03期
关键词
pre-eclampsia; placental growth factor; diagnostic algorithms; PLASMA-PROTEIN-A; FREE BETA-HCG; SERUM PAPP-A; PREGNANCY COMPLICATIONS; HYPERTENSIVE DISORDERS; PREDICTION; 1ST-TRIMESTER; RISK; 2ND-TRIMESTER; WOMEN;
D O I
10.17219/acem/62214
中图分类号
R-3 [医学研究方法]; R3 [基础医学];
学科分类号
1001 ;
摘要
Background. Pre-eclampsia is a systemic disease connected with high maternal and fetal morbidity and mortality. Despite significant progress achieved in perinatal medicine, pre-eclampsia is still one of the most significant current problems in obstetrics. Objectives. The aim of the study was to establish diagnostic algorithms for early and late pre-eclampsia (PE) and intrauterine growth restriction (IUGR). Material and methods. A total of 320 pregnant women between 11 + 0 and 13 + 6 weeks of gestation were recruited for a case-control study. The study group consisted of 22 patients with early PE, 29 patients with late PE and 269 unaffected controls. The following parameters were recorded: maternal history, mean arterial pressure (MAP), mean uterine artery pulsatility index (UtA-PI), and the concentrations of placental growth factor (PlGF), pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotropin (free beta-hCG). Results. A multivariable stepwise logistic regression analysis indicated that the best screening model for the prediction of early PE is based on a combined analysis of maternal risk factors, UtA-PI and PlGF levels (sensitivity: 91%; specificity: 84%). The best screening model for the prediction of late PE is based on a combined analysis of maternal risk factors, UtA-PI and MAP (sensitivity: 85%; specificity: 83%). The most effective screening model for the prediction of IUGR is based on a combined analysis of maternal risk factors, UtA-PI and PlGF concentrations (sensitivity: 91%; specificity: 83%). Conclusions. The integrated model of screening established in this study can be a valuable method to identify patients at increased risk of developing pre-eclampsia and related complications. The ability to predict the occurrence of pre-eclampsia in early pregnancy would enable maternal and fetal morbidity to be reduced through the introduction of strict obstetric surveillance as well as planned delivery in a reference center.
引用
收藏
页码:439 / 448
页数:10
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