Abstract
The current approach to screening for pre‐eclampsia is based on guidelines that rely on medical and obstetric history in early pregnancy to select a high‐risk group that might benefit from low‐dose aspirin. However, combined screening tests with the addition of biophysical and biochemical measurements have shown significantly better detection rates for preterm pre‐eclampsia. Furthermore, the administration of aspirin for the 10% screen‐positive group can lead to a significant reduction in severe and preterm forms of pre‐eclampsia. This review aims to answer frequently asked questions related to the clinical implementation of screening and the management of screening results.
Highlights
In the last updated Guideline, “Management of Hypertensive Disorders of Pregnancy”, in 2014, the Society of Obstetric Medicine of Australia and New Zealand recommends assessment of maternal medical and obstetric history for risk indicators that predispose women to pre-eclampsia (PE)
Women who are considered at high risk are recommended prophylactic treatment with low-dose aspirin,[1] as randomised trials and meta-analyses have shown a reduction in the risk of disease with this intervention.[2,3]
The Society of Obstetric Medicine of Australia and New Zealand advises screening for all women at their first prenatal visit by assessing for predisposing risk indicators according to maternal demographic characteristics, and medical and obstetric history.[1]
Summary
In the last updated Guideline, “Management of Hypertensive Disorders of Pregnancy”, in 2014, the Society of Obstetric Medicine of Australia and New Zealand recommends assessment of maternal medical and obstetric history for risk indicators that predispose women to pre-eclampsia (PE). The Society of Obstetric Medicine of Australia and New Zealand advises screening for all women at their first prenatal visit by assessing for predisposing risk indicators according to maternal demographic characteristics, and medical and obstetric history.[1] These guidelines are endorsed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. In their own prenatal screening statement from 2015,15 the Royal Australian and New Zealand College of Obstetricians and Gynaecologists acknowledged the potential role for ultrasound and biochemical markers in the prediction of PE. The risk cut-off used in PE screening is determined by: (i) the background prevalence of PE in a given population; (ii) the accepted SPR for treatment with aspirin; and (iii) cost-effectiveness analysis.[27]
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