OP12.02: First and second trimester combined screening for pre‐eclampsia

Abstract

Objectives:To determine the detection capacity of early-onset pre-eclampsia (ePE) with a combined first and second trimester screening model. Methods: Longitudinal study in 4,063 singleton pregnancies that attended for an 11 + 0 -13 + 6 and 20 + 0 -24 + 6 weeks ultrasound, which included the prediction of ePE by combining maternal history and Uterine Artery Doppler (UtAD) at first trimester (1T) and only UtAD at second trimester (2T). Maternal characteristics were prospectively entered into a database. An ePE 1T predictive model created in our Unit was used (S:60%, FPR:10%, cut-off 2.1%). The same patients were assessed at 20 + 0 -24 + 6 weeks with UtAD and re-classified in a high risk group of ePE according to mean UtAD pulsatility index (PI), if 95th centile was reached. Final high risk patients were selected by combining both models. Results: During the study period 129 patients developed PE (3.2%), of these 26(0.6%) were ePE (delivery <34 weeks). Independently, the ePE predictive models in 1T and 2T demonstrated a sensitivity and FPR of 42.3% (n = 11/26) and 9.5% vs 80.8% (n = 21/26) and 5.2%, respectively. When both models were combined, 387 patients were assigned at risk of ePE (9.5%) during the 1T. When UtAD was evaluated in this group during the 2T, only 72 patients were re-classified as a high risk of ePE (1.7%).In the combined high risk group is the 90.9% (n = 10/11) of patients detected during the 1T of pregnancy. The only patient not identified with the 2T model was a patient with chronic hypertension and lupus. Combined sensitivity of the sequential model was 38.5% (n = 10/26) with a combined FPR of 11.2%. Conclusions: This study confirms that 2T UtAD is better than 1T screening for ePE. However, because ePE prevention is based in the use of aspirin before 16 weeks, 1T screening is the best strategy to detect this condition. The combined model demonstrated a sensitivity of about 40% and a FPR of 11%, but with a 5-fold reduction of any preventive strategy started during the 1T.Objectives: Hypertensive disorders in pregnancy, mainly pre-eclampsia (PE), are responsible for high rates of maternal mortality around the world, in particular in developing countries, among them, Brazil. A significant percentage of these deaths could be avoided with proper monitoring and satisfactory prediction of the clinical onset of PE. The flow-mediated dilation of the brachial artery (FMD) is a biophysical marker of endothelial dysfunction, known to be a key factor in the development of PE. The objective was to access the accuracy of flow-mediated dilation of the brachial artery (FMD), in the prediction of early and late PE. Methods: A total of 91 patients, considered at high risk for PE development were recruited at our institution's prenatal service and subjected to FMD between 24 and 28 weeks of gestation.Results: From selected patients, 19 developed PE, 8 in its early form and 11 in its late form. Using a cut-off value of 6.5%, the sensitivity (S) of FMD for early PE prediction was 75.0%, with specificity (E) of 73.3%...