Elena Scazzocchio

Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting

OBJECTIVE We sought to evaluate the effectiveness of an integrated first-trimester screening test to predict preeclampsia (PE). STUDY DESIGN A prospective cohort of singleton pregnancies underwent routine first-trimester screening from 2009 through 2011 (n = 5759). A logistic regression-based predictive model for early- and late-onset PE was constructed based on: maternal characteristics; levels of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin at 8-12 weeks; and blood pressure and uterine artery Doppler at 11.0-13.6 weeks. RESULTS Of the 5170 enrolled participants, 136 (2.6%) developed PE (early PE: 26 [0.5%]; late PE: 110 [2.1%]). At 5% and 10% false-positive rates, detection rates were 69.2% and 80.8% for early PE (area under the curve, 0.95; 95% confidence interval, 0.94-0.98) and 29.4% and 39.6% for late PE (area under the curve, 0.71; 95% confidence interval, 0.66-0.76), respectively. CONCLUSION First-trimester screening combining maternal factors with uterine artery Doppler, blood pressure, and pregnancy-associated plasma protein-A is useful to predict PE in a routine care setting.

Contemporary prediction of preeclampsia.

Purpose of review To provide a concise review of advances in prediction of preeclampsia, highlighting the most important and interesting articles among the many published within the past months, making a clear distinction between early and late clinical forms of the condition. Recent findings The performance of maternal levels of angiogenic factors to predict preeclampsia, especially early-onset preeclampsia, could be further improved by combining several markers and by evaluating the longitudinal changes between the first and second trimester. Combining first trimester angiogenic factors with maternal history, mean blood pressure and uterine artery Doppler achieves a detection rate of approximately 90% for an approximately 10% of false positives for early preeclampsia. The incorporation of parameters reflecting maternal vascular stiffness into multiparametric models in contingent strategies might result in fewer tests than concurrent screening, with similar prediction performance. Summary Combining several tests into multiparametric models results in the early identification of the vast majority of cases bound to develop early preeclampsia, which is the clinical form that most contributes to adverse maternal and perinatal outcome. This may allow more efficient allocation of resources according to the individual risk and the evaluation of prophylactic strategies in a selected subgroup of women.

First-trimester screening for early and late small-for-gestational-age neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler.

To assess the effectiveness of first‐trimester screening for early and late small‐for‐gestational‐age (SGA) neonates using maternal serum biochemistry, blood pressure and uterine artery Doppler.

Contingent versus routine third-trimester screening for late fetal growth restriction.

To evaluate the use of third‐trimester ultrasound screening for late fetal growth restriction (FGR) on a contingent basis, according to risk accrued in the second trimester, in an unselected population.

Vaginal progesterone as maintenance treatment after an episode of preterm labour (PROMISE) study: a multicentre, double‐blind, randomised, placebo‐controlled trial

To evaluate whether maintenance treatment with vaginal progesterone after an arrested preterm labour reduces the incidence of preterm delivery.

Validation of a first-trimester screening model for pre-eclampsia in an unselected population

To validate the performance of a previously constructed first‐trimester predictive model for pre‐eclampsia (PE) in routine care of an unselected population.

Changes in uterine artery Doppler velocimetry and circulating angiogenic factors in the first half of pregnancies delivering a small‐for‐gestational‐age neonate

To assess the relationship between longitudinal changes in placental Doppler indices and maternal circulating angiogenic factors in the first half of pregnancy and delivery of a small‐for‐gestational‐age (SGA) neonate, and ascertain whether longitudinal evaluation of these variables improves the prediction achieved by second‐trimester cross‐sectional evaluation.

Role of maternal plasma levels of placental growth factor for the prediction of maternal complications in preeclampsia according to the gestational age at onset

This study aimed to describe the distribution of placental growth factor (PlGF) plasma levels in pregnancies complicated by preeclampsia (PE) according to the gestational age at clinical onset and to assess PlGFs predictive role for maternal complications.

OP17.01: First trimester screening for early and late small for gestational age

B. Deloison1,2, P. Sonigo3, A. Millischer3, N. Bahi-Buisson4, G. E. Chalouhi1,2, N. E. Russell1, F. Brunelle3, N. Boddaert4, Y. Ville1,2, L. J. Salomon1,2 1Obstetrics and Gynecology, University Paris Descartes, Sorbonne Paris Cite, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France; 2SFAPE Société Francaise pour l’Amélioration des Pratiques Echographiques, Paris, France; 3Pediatric Radiology, University Paris Descartes, Sorbonne Paris Cite, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France; 4Pediatric Neurology, University Paris Descartes, Sorbonne Paris Cite, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France