Integrating Combined First Trimester Screening for Preeclampsia into Routine Ultrasound Examination

Trottmann, Fabienne; Mollet, Anne Elena; Amylidi-Mohr, Sofia; Surbek, Daniel; Raio, Luigi; Mosimann, Beatrice

doi:10.1055/a-1534-2599

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…The value of PAPP-A in screening for PE has been extensively discussed; including PAPP-A into routine screening for pPE does not improve the performance of screening [12, 20, 21]. Screening for aneuploidies is offered to all pregnant women in Switzerland and there is a high acceptance for such screening [32]. PAPP-A is therefore often obtained for aneuploidy screening and routinely included into PE-screening.…”

Section: Discussionmentioning

confidence: 99%

Implementing Preeclampsia Screening in Switzerland (IPSISS): First Results from a Multicentre Registry

Trottmann¹,

Challande²,

Manegold-Brauer³

et al. 2023

Fetal Diagn Ther

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Introduction The Fetal Medicine Foundation(FMF) London developed a first trimester combined screening algorithm for preterm preeclampsia(pPE) that allows a significantly higher detection of pregnancies at risk compared to conventional screening by maternal risk factors only. The aim of this trial is to validate this screening model in the Swiss population in order to implement this screening into routine first trimester ultrasound and to prescribe low dose aspirin 150mg(LDA) in patients at risk for pPE. Therefore, a multicentre registry study collecting screening and pregnancy outcome data was initiated in2020;these are the preliminary results. Methods Between June1st2020 and May31st2021 we included singleton pregnancies with pPE screening at the hospitals of Basel, Lucerne and Bern. Multiple of Medians(MoMs) of uterine artery pulsatility index(UtA-PI), mean arterial pressure(MAP), placental growth factor(PlGF) and pregnancy associated plasma protein A(PAPP-A) as well as risks were analysed as calculated by each centre’s software and recalculated on the FMF online calculator for comparative reasons. Statistical analyses were performed by GraphPad Version9.1. Results During the study period 1027patients with singleton pregnancies were included. 174(16.9%) had a risk>1:100 at first trimester combined screening. Combining the background risk, MAP, UtA-PI and PlGF only, the cut-off to obtain a SPR of 11% is≥1:75. Outcomes were available for 968/1027(94.3%) patients, 951 resulted in live birth. 15(1.58%) developed classical PE, 23(2.42%) developed PE according to the ISSHP(International Society for the Study of Hypertension in Pregnancy) definition. Conclusion First trimester combined screening for PE and prevention with LDA results in a low prevalence of PE.The screening algorithm performs according to expectations, however the cut-off of>1:100 results in a SPR above the accepted range and a cut-off of≥1:75 should be considered for screening. More data are needed to evaluate, if these results are representative for the general Swiss population.

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Section: Discussionmentioning

confidence: 99%

Implementing Preeclampsia Screening in Switzerland (IPSISS): First Results from a Multicentre Registry

Trottmann¹,

Challande²,

Manegold-Brauer³

et al. 2023

Fetal Diagn Ther

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“…Studies have shown that uterine artery hemodynamic parameters in patients with preeclampsia are signifcantly higher than those in normal pregnant women [19]. Ultrasound technology enables the noninvasive and real-time assessment of hemodynamic parameters in vital organs of pregnant women and fetuses [20]. However, till date, the roles of serum SIRT1 and uterine hemodynamics in the progression of preeclampsia are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

Kong

2023

Evidence-Based Complementary and Alternative Medicine

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Objective. The sirtuin regulator 1-related enzyme (SIRT1) has been shown to play an important role in various pathophysiological processes. Our aim was to investigate the effect and correlation of serum SIRT1 combined with uterine hemodynamic parameters on disease severity and fetal uterine growth restriction in the progression of preeclampsia and to evaluate its clinical value as a potential marker. Methods. A total of 100 patients with preeclampsia who were hospitalized in Qufu Normal University Hospital from June 2017 to June 2021 were selected as the research objects. According to the severity, they were divided into the mild (62 cases) and severe groups (38 cases), and according to whether the fetal growth restriction was combined or not, they were divided into the combined fetal growth restriction group (56 cases) and the uncomplicated fetal growth restriction group (44 cases). Serum SIRT1 expression and uterine artery hemodynamic parameters were detected, and Spearman analysis was used to evaluate the association of serum SIRT1 expression and uterine artery hemodynamic parameters (the peak-to-trough ratio of arterial blood velocity, the pulsatility index, and the resistance index) with disease severity (systolic blood pressure, diastolic blood pressure, and random urinary protein levels) and fetal growth restriction (femoral length, biparietal diameter, head circumference, and neonatal weight); unsupervised principal component analysis (PCA), supervised partial least-squares discrimination analysis (PLS-DA), cluster heat map analysis, the receiver operating characteristic (ROC) curve, and the area under curve (AUC) were used to evaluate the diagnostic value of serum SIRT1 expression combined with uterine artery hemodynamic parameters in the severity of disease and fetal growth restriction in patients with preeclampsia. Results. Compared with patients with mild preeclampsia, serum SIRT1 expression was lower in patients with severe preeclampsia ( p < 0.0001 ), the arterial blood flow velocity peak-to-trough ratio, pulsatility index, and resistance index were higher ( p < 0.001 ; p < 0.0001 ); and serum SIRT1 expression and uterine artery hemodynamic parameters were closely related to disease severity ( p < 0.001 ; p < 0.0001 ). In addition, the expression of serum SIRT1 in patients with preeclampsia combined with fetal growth restriction was lower than patients without preeclampsia ( p < 0.0001 ); the peak-to-trough ratio of arterial blood flow velocity, the pulsatility index, and the resistance index were higher ( p < 0.0001 ); and serum SIRT1 expression and uterine artery hemodynamics were closely related to fetal growth restriction ( p < 0.0001 ). Unsupervised PCA analysis and supervised PLS-DA analysis showed that patients with different severity of disease and patients with or without fetal growth restriction were similar within the groups, and there were significant differences between the groups; cluster heat map analysis showed that the mild and severe groups were stratified clustering, and the combined fetal growth restriction group and the uncombined group were hierarchically clustered; ROC curve showed that the AUC of serum SIRT1 expression combined with uterine artery hemodynamic parameters was 0.776 in identifying the severity of preeclampsia and 0.956 in identifying the preeclampsia complicated by fetal growth restriction. Conclusion. Serum SIRT1 combined with uterine hemodynamic parameters in preeclampsia is closely related to disease severity and fetal growth restriction and is expected to become a potential biomarker for early clinical intervention in patients.

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“…In Switzerland first trimester ultrasound screening as part of routine pregnancy care has a high uptake and acceptance 26 . As recently published, about 90% of women presenting for first trimester ultrasound decide to screen for fetal trisomies 26 . Switzerland was one of the first countries worldwide to implement cffDNA into routine screening in 2015 18 .…”

Section: Discussionmentioning

confidence: 99%

First Trimester Contingent Screening for Aneuploidies with Cell-Free Fetal DNA in Singleton Pregnancies – a Swiss Single Centre Experience

Proto,

Trottmann,

Schneider

et al. 2024

Geburtshilfe Frauenheilkd

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Switzerland was amongst the first countries to offer cell-free fetal DNA (cffDNA) testing covered by the health insurance to pregnant women with a risk ≥ 1:1000 for trisomies at first trimester combined screening (FTCS). The aim of this study is to evaluate the implementation of this contingent model in a single tertiary referral centre and its effect on gestational age at diagnosing trisomy 21.Between July 2015 and December 2020 all singleton pregnancies at 11–14 weeks of gestation without major fetal malformation were included and stratified according to their risk at FTCS. Statistical analysis was performed by GraphPad Version 9.1 for Windows.4424 pregnancies were included. Of 166 (3.8%) pregnancies with a NT ≥ 3.5 mm and/or a risk ≥ 1:10 at FCTS, 130 (78.3%) opted for direct invasive testing. 803 (18.2%) pregnancies had an intermediate risk, 692 (86.2%) of them opted for cffDNA first. 3455 (78.1%) pregnancies had a risk < 1:1000. 63 fetuses were diagnosed with trisomy 21, 47 (74.6%) directly by invasive procedures after FTCS, 16 (25.4%) by cffDNA first.Most women choose cffDNA or invasive testing as second tier according to national guidelines. Despite the delay associated with cffDNA testing after FCTS, 75% of all trisomy 21 are still diagnosed in the first trimester with this contingent screening model.

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Integrating Combined First Trimester Screening for Preeclampsia into Routine Ultrasound Examination

Cited by 6 publications

References 39 publications

Implementing Preeclampsia Screening in Switzerland (IPSISS): First Results from a Multicentre Registry

Implementing Preeclampsia Screening in Switzerland (IPSISS): First Results from a Multicentre Registry

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

First Trimester Contingent Screening for Aneuploidies with Cell-Free Fetal DNA in Singleton Pregnancies – a Swiss Single Centre Experience

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