Screening for pre‐eclampsia at 35–37 weeks' gestation

Panaitescu, Anca Maria; Ciobanu, Anca Marina; Syngelaki, Argyro; Wright, Alan; Wright, David; Nicolaides, Kypros H.

doi:10.1002/uog.19111

Cited by 66 publications

(70 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An integrated clinical assessment at 35-37 weeks' gestation, which includes fetal biometry and measurement of biomarkers, identifies a high proportion of pregnancies that subsequently develop PE and those delivering a SGA neonate [1][2][3][4][5][6] . Contrary to the expectation that the same biomarkers would be useful in predicting adverse perinatal outcome, this did not prove to be the case.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

“…Assessment of pregnancy at 35–37 weeks' gestation is useful in the prediction of subsequent development of pre‐eclampsia (PE) and the birth of a small‐for‐gestational‐age (SGA) neonate. Both conditions are associated with impaired placentation and/or placental dysfunction, reflected in increased pulsatility index (PI) in the uterine arteries (UtAs), reduced serum level of the angiogenic placental growth factor (PlGF) and increased level of the antiangiogenic factor soluble fms‐like tyrosine kinase‐1 (sFlt‐1).…”

Section: Introductionmentioning

confidence: 99%

“…Fifth, the relative risk of UtA-PI > 95 th , sFlt-1 > 95 th and PlGF < 5 th percentiles for most adverse outcomes was < 2.5 in both SGA and non-SGA neonates. conditions are associated with impaired placentation and/or placental dysfunction, reflected in increased pulsatility index (PI) in the uterine arteries (UtAs), reduced serum level of the angiogenic placental growth factor (PlGF) and increased level of the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1) [1][2][3][4][5][6] .…”

mentioning

confidence: 99%

See 2 more Smart Citations

Biomarkers of impaired placentation at 35–37 weeks' gestation in the prediction of adverse perinatal outcome

Ciobanou

Jabak

Castro

et al. 2019

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

Objective To investigate the potential value of uterine artery pulsatility index (UtA‐PI) and serum levels of the angiogenic placental growth factor (PlGF) and the antiangiogenic factor soluble fms‐like tyrosine kinase‐1 (sFlt‐1) in the prediction of adverse perinatal outcome in small‐for‐gestational‐age (SGA) and non‐SGA neonates at 35–37 weeks' gestation. Methods This was a prospective observational study of 19 209 singleton pregnancies attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, sonographic estimation of fetal weight, color Doppler ultrasound for measurement of mean UtA‐PI, and measurement of serum concentrations of PlGF and sFlt‐1. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal or pregnancy characteristics and measurements of UtA‐PI, PlGF and sFlt‐1 provided a significant contribution in the prediction of each of four adverse outcome measures: first, stillbirth; second, Cesarean delivery for suspected fetal compromise in labor; third, neonatal death or hypoxic ischemic encephalopathy Grade 2 or 3; and, fourth, admission to the neonatal unit (NNU) for ≥ 48 h. Predicted probabilities from logistic regression analysis were used to construct receiver–operating characteristics curves to assess the performance of screening for these adverse outcomes. Results First, 83% of stillbirths, 82% of Cesarean sections for presumed fetal compromise in labor, 91% of cases of neonatal death or hypoxic ischemic encephalopathy and 86% of NNU admissions for ≥ 48 h occurred in pregnancies with a non‐SGA neonate. Second, UtA‐PI > 95th percentile, sFlt‐1 > 95th percentile and PlGF < 5th percentile were associated with increased risk of Cesarean delivery for suspected fetal compromise in labor and NNU admission for ≥ 48 h; the number of stillbirths and cases of neonatal death or hypoxic ischemic encephalopathy was too small to demonstrate significance in the observed differences from cases without these adverse outcomes. Third, multivariable logistic regression analysis demonstrated that, in the prediction of Cesarean delivery for suspected fetal compromise in labor, there was no significant contribution from biomarkers; the prediction of NNU admission for ≥ 48 h by maternal demographic characteristics and medical history was only marginally improved by the addition of sFlt‐1 or PlGF. Fourth, for each biomarker, the detection rate of adverse outcome was higher in SGA than in non‐SGA neonates, but this increase was accompanied by an increase in false‐positive rate. Fifth, the relative risk of UtA‐PI > 95th, sFlt‐1 > 95th and PlGF < 5th percentiles for most adverse outcomes was < 2.5 in both SGA and non‐SGA neonates. Conclusions In pregnancies undergoing routine antenatal assessment at 35–37 weeks' gestation, measurements of UtA‐PI, sFlt‐1 or PlGF provide poor prediction of adverse perinatal outcome in both SGA and non‐SGA fetuses. Copyright © 20...

show abstract

Section: Implications For Clinical Practicementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Biomarkers of impaired placentation at 35–37 weeks' gestation in the prediction of adverse perinatal outcome

Ciobanou

Jabak

Castro

et al. 2019

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

show abstract

“…Fourth, the competing‐risks model has been successfully applied for assessment of risk for PE and stratification of pregnancy care by a combination of maternal factors and biomarkers in the first, second and third trimesters of pregnancy. In the first trimester, the competing‐risks approach utilizing maternal factors, MAP, UtA‐PI and PlGF was used to identify women at high risk of developing preterm PE; at a 10% screen‐positive rate, 90% of early‐PE cases and 75% of those with preterm PE were predicted in both a training dataset of 35 948 singleton pregnancies and in two independent, non‐intervention, multicenter studies involving 8775 and 16 451 singleton pregnancies, respectively.…”

mentioning

confidence: 99%

“…Consequently, appropriate evaluation and application of biomarkers in screening requires prior standardization by expressing the measured values as multiples of the median (MoM) [28][29][30][31] . In pregnancies that develop PE, MoM values of MAP, UtA-PI and sFlt-1 tend to be higher and PlGF tends to be lower than in normal pregnancies; the effect size increases with increasing severity of the disease, quantified by the gestational age at delivery 5-8 .Fourth, the competing-risks model has been successfully applied for assessment of risk for PE and stratification of pregnancy care by a combination of maternal factors and biomarkers in the first, second and third trimesters of pregnancy [32][33][34][35][36][37][38][39][40][41][42][43][44] . In the first trimester, the competing-risks approach utilizing maternal factors, MAP, UtA-PI and PlGF was used to identify women at high risk of developing preterm PE; at a 10% screen-positive rate, 90% of early-PE cases and 75% of those with preterm PE were predicted in both a training dataset of 35 948 singleton pregnancies and in two independent, non-intervention, multicenter studies involving 8775 and 16 451 singleton pregnancies, respectively 32,[45][46][47][48] .…”

mentioning

confidence: 99%