Combined Screening for Preeclampsia and Small for Gestational Age at 11–13 Weeks

Poon, Liona C.; Syngelaki, Argyro; Akolekar, Ranjit; Lai, Jasmine; Nicolaides, Kypros H.

doi:10.1159/000341712

Cited by 188 publications

(176 citation statements)

References 47 publications

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“…It is therefore likely that inclusion of PLGF and AFP, which can be measured in the same sample and by the same automated machines used for free β-hCG and PAPP-A at little extra cost, would be beneficial in screening for trisomies. There is also evidence that serum PLGF and AFP are useful in first-trimester screening for preeclampsia, fetal growth restriction and preterm birth [16,17,18]. Similarly, measurement of DV PIV can improve the performance of screening for trisomies and it is also useful in screening for major cardiac defects [7,19,20].…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing

et al. 2013

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Objective: To examine the performance of screening for trisomies 21, 18 and 13 at 11-13 weeks' gestation using specific algorithms for these trisomies based on combinations of fetal nuchal translucency thickness (NT), fetal heart rate (FHR), ductus venosus pulsatility index for veins (DV PIV), and serum free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PLGF) and α-fetoprotein (AFP). Methods: Model-based estimates of screening performance were produced for the distribution of maternal ages in England and Wales in 2011, and prospectively collected data on fetal NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP from singleton pregnancies undergoing aneuploidy screening. Results: In screening by NT, FHR, free β-hCG and PAPP-A, using specific algorithms for trisomy 21 and trisomies 18 and 13 at the risk cutoff of 1:100, the estimated detection rate (DR) was 87.0% for trisomy 21 and 91.8% for trisomies 18 and 13, at a false-positive rate (FPR) of 2.2%. Addition of PLGF, AFP and DV PIV increased the DR to 93.3% for trisomy 21 and 95.4% for trisomies 18 and 13 and reduced the FPR to 1.3%. Conclusions: Effective screening for trisomies can be achieved using specific algorithms based on NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP.

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Section: Discussionmentioning

confidence: 99%

First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing

et al. 2013

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“…Measurement of serum PLGF and AFP can be performed in the same sample and by the same automated machines used for free β-hCG and PAPP-A at little extra cost. Additionally, these metabolites are useful in first-trimester screening for preeclampsia, fetal growth restriction and preterm birth [26,27,28]. Measurement of DV PIV can improve the performance of screening for trisomies considerably and it is also useful in screening for major cardiac defects [29,30,31].…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Contingent Screening for Trisomies 21, 18 and 13 by Biomarkers and Maternal Blood Cell-Free DNA Testing

et al. 2013

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Objective: To examine potential performance of screening for trisomies by cell-free (cf) DNA testing in maternal blood contingent on results of first-line testing by combinations of fetal translucency thickness (NT), fetal heart rate (FHR), ductus venosus pulsatility index (DV PIV), and serum-free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PLGF) and α-fetoprotein (AFP). Methods: Performance was estimated for firstly, screening by cfDNA in all pregnancies and secondly, cfDNA testing contingent on results of first-line testing by combinations of ultrasound and biochemical markers. Results: In first-line screening by cfDNA testing, the detection rate for trisomy 21 and trisomies 18 or 13 would be 99 and 96%, respectively, after invasive testing in 1% of the population. In contingent screening, a detection rate of 98% for trisomy 21 and 96% for trisomy 18 or 13, at an invasive testing rate of 0.7%, can be achieved by carrying out cfDNA testing in about 35, 20 and 11% of cases identified by first-line screening with the combined test alone (age, NT, FHR, β-hCG, PAPP-A), the combined test plus PLGF and AFP and the combined test plus PLGF, AFP and DV PIV, respectively. Conclusions: Effective first-trimester screening for trisomies can be achieved by contingent screening incorporating biomarkers and cfDNA testing.

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“…They showed a detection rate of about 30% at a false positive rate of 10%, and suggested this method could improve the prediction of SGA and LGA neonates compared to using maternal characteristics alone. This same team even set up specific risk algorithms for screening SGA neonates and preeclampsia by a combination of maternal characteristics and history with biochemical (PAPP-A, PLGF) and biophysical markers (uterine artery pulsatility index, MAP) [22,23]. Similarly, the study conducted by Schwartz et al [24] built a multivariable model of combining indirect markers of placental development (PLGF and placental protein 13) and direct assessment of the placenta at around 11-14 weeks of gestation for the early prediction of SGA.…”

Section: Discussionmentioning

confidence: 99%

Second-Trimester Placental Volume and Vascular Indices in the Prediction of Small-for-Gestational-Age Neonates

Fang¹,

Ou²,

Tsai³

et al. 2014

Fetal Diagn Ther

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Objective: To evaluate the ability of second-trimester placental volume and vascular indices to predict small-for-gestational-age (SGA) birth weight pregnancies. Material and Methods: Women with singleton pregnancies were prospectively evaluated at 17-20 weeks of gestation. Second-trimester placental volume and vascular indices were obtained and calculated using volume organ computer-aided analysis and three-dimensional (3D) power Doppler ultrasound. Participants were followed until delivery and their medical records were reviewed, including maternal age, parity and pregestational body weight and body height, as well as the gestational age, birth weight and gender of the fetus. Results: Of the 163 women with complete follow-up, 20 gave birth to SGA and 143 to appropriate-for-gestational-age (AGA) neonates. The mean second-trimester placental volume was significantly lower in the SGA than in the AGA group (170.6 ± 49.8 vs. 213.5 ± 75.8 cm³, p = 0.015). None of the vascular indices, including the vascularization index, flow index and vascularization flow index, differed significantly between the two groups. We also found that the optimum cutoff for placental volume at a gestational age of 17-18 weeks was 189.7 cm³. Discussion: Second-trimester placental volume was positively correlated with neonatal birth weight. Second-trimester placental volume measured on 3D ultrasound may be predictive of SGA neonates.

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Combined Screening for Preeclampsia and Small for Gestational Age at 11–13 Weeks

Cited by 188 publications

References 47 publications

First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing

First-Trimester Screening for Trisomies 21, 18 and 13 by Ultrasound and Biochemical Testing

First-Trimester Contingent Screening for Trisomies 21, 18 and 13 by Biomarkers and Maternal Blood Cell-Free DNA Testing

Second-Trimester Placental Volume and Vascular Indices in the Prediction of Small-for-Gestational-Age Neonates

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