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Early prediction of preeclampsia.

Poon LC, Nicolaides KH - Obstet Gynecol Int (2014)

Bottom Line: Effective screening for the development of early onset preeclampsia (PE) can be provided in the first-trimester of pregnancy.Screening by a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.

View Article: PubMed Central - PubMed

Affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK.

ABSTRACT
Effective screening for the development of early onset preeclampsia (PE) can be provided in the first-trimester of pregnancy. Screening by a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.

No MeSH data available.


Related in: MedlinePlus

Distribution of gestational age at delivery for preeclampsia (PE). In pregnancies at low-risk for PE the gestational age distribution is shifted to the right and in most pregnancies delivery will occur before the development of PE. In pregnancies at high-risk for PE the distribution is shifted to the left. The risk of PE occurring at or before a specified gestational age is given by the area under the distribution curve (black). In the low-risk group the risk of PE at or before 34 weeks' gestation is 0.01 or 1% and in the high-risk group the risk is 0.6 or 60%.
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fig1: Distribution of gestational age at delivery for preeclampsia (PE). In pregnancies at low-risk for PE the gestational age distribution is shifted to the right and in most pregnancies delivery will occur before the development of PE. In pregnancies at high-risk for PE the distribution is shifted to the left. The risk of PE occurring at or before a specified gestational age is given by the area under the distribution curve (black). In the low-risk group the risk of PE at or before 34 weeks' gestation is 0.01 or 1% and in the high-risk group the risk is 0.6 or 60%.

Mentions: It has been demonstrated that maternal demographic characteristics, including medical and obstetric history (Table 2), are potentially useful in screening for PE only when the various factors are incorporated into a combined algorithm derived by multivariate analysis [18]. With this approach to screening the effects of variables are expressed as odds ratios for early onset, late onset, or total PE. In general, the maternal risk factor profiles vary between early onset PE and late onset PE. This has led to the view that early and late PE may be different diseases. An alternative view is that PE is a spectrum disorder the degree of which is reflected in gestational age at the time of delivery. Multivariate screening for PE with maternal risk factors has since evolved into a new approach in which the gestation at the time of delivery for PE is treated as a continuous rather than a categorical variable. This approach, which is based on a survival time model, assumes that if the pregnancy was to continue indefinitely, all women would develop PE and whether they do so or not before a specified gestational age depends on a competition between delivery before or after development of PE [12]. In this new approach the effect of various risk factors is to modify the mean of the distribution of gestational age at delivery with PE. In pregnancies at low-risk for PE the gestational age distribution is shifted to the right with the implication that in most pregnancies delivery will actually occur before the development of PE. In high-risk pregnancies the distribution is shifted to the left and the smaller the mean gestational age, the higher the risk for PE (Figure 1).


Early prediction of preeclampsia.

Poon LC, Nicolaides KH - Obstet Gynecol Int (2014)

Distribution of gestational age at delivery for preeclampsia (PE). In pregnancies at low-risk for PE the gestational age distribution is shifted to the right and in most pregnancies delivery will occur before the development of PE. In pregnancies at high-risk for PE the distribution is shifted to the left. The risk of PE occurring at or before a specified gestational age is given by the area under the distribution curve (black). In the low-risk group the risk of PE at or before 34 weeks' gestation is 0.01 or 1% and in the high-risk group the risk is 0.6 or 60%.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4127237&req=5

fig1: Distribution of gestational age at delivery for preeclampsia (PE). In pregnancies at low-risk for PE the gestational age distribution is shifted to the right and in most pregnancies delivery will occur before the development of PE. In pregnancies at high-risk for PE the distribution is shifted to the left. The risk of PE occurring at or before a specified gestational age is given by the area under the distribution curve (black). In the low-risk group the risk of PE at or before 34 weeks' gestation is 0.01 or 1% and in the high-risk group the risk is 0.6 or 60%.
Mentions: It has been demonstrated that maternal demographic characteristics, including medical and obstetric history (Table 2), are potentially useful in screening for PE only when the various factors are incorporated into a combined algorithm derived by multivariate analysis [18]. With this approach to screening the effects of variables are expressed as odds ratios for early onset, late onset, or total PE. In general, the maternal risk factor profiles vary between early onset PE and late onset PE. This has led to the view that early and late PE may be different diseases. An alternative view is that PE is a spectrum disorder the degree of which is reflected in gestational age at the time of delivery. Multivariate screening for PE with maternal risk factors has since evolved into a new approach in which the gestation at the time of delivery for PE is treated as a continuous rather than a categorical variable. This approach, which is based on a survival time model, assumes that if the pregnancy was to continue indefinitely, all women would develop PE and whether they do so or not before a specified gestational age depends on a competition between delivery before or after development of PE [12]. In this new approach the effect of various risk factors is to modify the mean of the distribution of gestational age at delivery with PE. In pregnancies at low-risk for PE the gestational age distribution is shifted to the right with the implication that in most pregnancies delivery will actually occur before the development of PE. In high-risk pregnancies the distribution is shifted to the left and the smaller the mean gestational age, the higher the risk for PE (Figure 1).

Bottom Line: Effective screening for the development of early onset preeclampsia (PE) can be provided in the first-trimester of pregnancy.Screening by a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.

View Article: PubMed Central - PubMed

Affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, UK.

ABSTRACT
Effective screening for the development of early onset preeclampsia (PE) can be provided in the first-trimester of pregnancy. Screening by a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.

No MeSH data available.


Related in: MedlinePlus