Diagnostic Performance of First Trimester Screening of Preeclampsia Based on Uterine Artery Pulsatility Index and Maternal Risk Factors in Routine Clinical Use

Abstract

Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clínica Dávila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study.

The Relationship between Age, Parity, Early Detection, K1-K4 Visits, Integrated ANC, Three Times Obgyn’s Ultrasound Examination, and Maternal Mortality

“…Through early detection, it is possible to anticipate the incidence of hypertension in pregnant women. Early detection is done by hemodynamic screening for circulatory disorders, to improve maternal-fetal outcomes, it can be done by selecting the right intervention (Phillips et al, 2020).In addition, early detection is very important for pregnant women who are at risk of preeclampsia in the first trimester (Mönckeberg et al, 2020).…”

Predicción de los grandes síndromes obstétricos

“…Es interesante que la mayoría de los síndromes obstétricos tienen una larga fase subclínica y sus expresiones clínicas son manifestaciones tardías de los procesos fisiopatológicos que los ocasionan 5 . Por ejemplo, la infección intraamniótica 7,8 y el acortamiento cervical [9][10][11] pueden ser asintomáticos y asociarse con un resultado adverso perinatal semanas después; igualmente, las alteraciones del Doppler de las arterias uterinas [12][13][14] y los cambios en las concentraciones de factores angiogénicos y antiangiogénicos [15][16][17] preceden en semanas al desarrollo de un cuadro de preeclampsia o de restricción del crecimiento fetal.…”