Marker For Prediction Of Preeclampsia Research Articles

Associations between Maternal sFlt-1/PlGF Ratio and Perinatal and Neonatal Outcomes in Newborns Born to Mothers with Preeclampsia

Purpose: The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is considered a predictive marker of preeclampsia. However, the relationship between the sFlt-1/PlGF ratio and perinatal and neonatal outcomes remains unknown. This study aimed to determine the associations of the sFlt-1/PlGF ratio with perinatal and neonatal outcomes in newborns born to mothers with preeclampsia.Methods: This retrospective cohort study reviewed singleton neonates born to mothers with preeclampsia who underwent testing for the sFlt-1/PlGF ratio. We investigated the relationship between maternal sFlt-1/PlGF ratios and gestational age (GA), birth weight (Bwt), Bwt z-score, morbidities, and mortality of neonates born to mothers tested for the sFlt-1/PlGF ratio. Maternal sFlt-1/PlGF ratios examined within 30 days before delivery were used for analysis. Neonatal morbidities and mortality were investigated only in preterm infants born earlier than 32 weeks GA.Results: A total of 225 neonates were included, of which 163 (72.4%) were preterm infants. GA (<i>R</i>=– 0.577, <i>p</i><0.001), Bwt (<i>R</i>=–0.713, <i>p</i><0.001), and Bwt z-score (<i>R</i>=–0.608, <i>p</i><0.001) exhibited significant negative correlations with the sFlt-1/PlGF ratios. Among the 50 preterm infants born earlier than 32 weeks GA, neonatal morbidities were not significantly associated with the sFlt-1/PlGF ratio after adjusting for GA and Bwt.Conclusion: In mothers with preeclampsia, a higher sFlt-1/PlGF ratio was associated with the delivery of newborns with lower GA and lower Bwt. However, this ratio was not associated with increased morbidity or mortality in premature infants born earlier than 32 weeks GA.

“A CO-RELATION OF FIRST TRIMESTER LEVELS OF PAPP-A (PREGNANCY ASSOCIATED PLASMA PROTEIN A) AND PIGF (PLACENTA INDUCED GROWTH FACTOR) WITH CO RELATION OF PREECLAMPSIA AND FETOMATERNAL OUTCOME.”

Introduction: Preeclampsia is one of the major cause of maternal and fetal mortality. Pathogenesis of development of preeclampsia is still not clear but one of the cause is considered to be abnormal placentation. Various markers haven been found to be involved in process of placentation among which PAPP-A and PIGF have been found to be actively involved. PAPP-A and PIGF levels have not been studied in the Indian population in terms of preeclampsia prediction at 10-14 weeks of gestation, and we intend to study their levels for early preeclampsia prediction. Methodology: This observational study was carried out in obstetrics and gynecology OPD , Sir T Hospital , Bhavnagar from June-2021 to August 2022. Total of 100 antenatal patients attending OPD who were in rst trimester taken after considering inclusion and exclusion criteria. Investigations for PAPP-A and PIGF were taken and patient followed up for development of preeclampsia till delivery. Incidence of preeclampsia was found to be 22%. Majority of patients Results: were found in age group of 26-30 years. More number of patients were multigravida who developed preeclampsia. PAPP-A during rst trimester were found as 1.06 ± 0.20 MoM in overall patients, while PIGF found as 0.97 ± 0.18 MoM. Moreover, mean PAPP-A and PIGF of control and case group were found as (1.11 ± 0.22 MoM vs 0.91 ± 0.21 MoM; p<0.0001) and (0.99 ± 0.17 MoM vs 0.88 ± 0.20 MoM; p<0.0001) respectively. 90% of babies delivered full term. In women with preeclampsia 10% patients had preterm delivery. 50% babies were low birth weight in women who developed preeclampsia. Keepi Conclusion: ng the complications associated with preeclampsia, measurement of PAPP-A and PIGF levels in rst trimester can be used as marker for prediction of preeclampsia in later months of pregnancy. Levels if found lower can help in taking regular follow up of patients and early diagnosis and management can be done. This can help us prevent maternal as well as fetal morbidity and mortality.

Arterial Stiffness as a Cardiovascular Risk Factor for the Development of Preeclampsia and Pharmacopreventive Options

Arterial Stiffness (AS) describes the rigidity of the arterial walls. Epidemiological studies have shown that increased AS is an independent predictive marker of Cardiovascular (CV) morbidity and mortality in both pregnant and non-pregnant women. Preeclampsia (PE), a form of pregnancy-induced hypertension, affects approximately 5% of pregnancies worldwide. Preeclamptic women have a higher risk of CV Disease (CVD), mainly because PE damages the heart's ability to relax between contractions. Different pharmacological approaches for the prevention of PE have been tested in clinical trials (e.g., aspirin, enoxaparin, metformin, pravastatin, and sildenafil citrate). In current clinical practice, only low-dose aspirin is used for PE pharmacoprevention. However, low-dose aspirin does not prevent term PE, which is the most common form of PE. Compromised vascular integrity precedes the onset of PE and therefore, AS assessment may constitute a promising predictive marker of PE. Several non-invasive techniques have been developed to assess AS. Compared with normotensive pregnancies, both Carotid-Femoral Pulse Wave Velocity (cfPWV) and Augmentation Index (AIx) are increased in PE. In view of simplicity, reliability, and reproducibility, there is an interest in oscillometric AS measurements in pregnancies complicated by PE.

A pattern of platelet indices as a potential marker for prediction of pre-eclampsia among pregnant women attending a Tertiary Hospital, Ethiopia: A case-control study.

Preeclampsia is the most serious health risk during pregnancy for both the mother and the fetus. Even though platelet parameters are among the proposed biomarkers for the prediction of preeclampsia, the use of its indices in the diagnosis of preeclampsia is not increasing in Ethiopia. There is little information on platelet patterns in preeclampsia and normal pregnancy. The purpose of this study was to determine the pattern of platelet indices in women with preeclampsia in our study setting. A case-control study was conducted among 180 pregnant women who attended anti-natal follow-ups from January 1 to April 3, 2019. An Ethylene Diamine Tetra Acetic Acid anti-coagulated venous blood was collected and analyzed using a hematology analyzer (MINDRAY®-BC-300Plus, Shenzhen China). The SPSS software version 26 was used to run the Mann Whitney U test, Kruskal-Wallis H test, and Kolmogorov-Smirnov normality test, Post-hock test augmented with Benforeni, receiver operating characteristics curve, and Spear Man rank-order correlation. A P-value of <0.05 was considered statistically significant. A total of 180 pregnant women were included in the study. Platelet count and platelet crit levels tend to decrease as pre-eclampsia becomes more severe. In contrast, the mean platelet volume and platelet distribution widths were significantly increased with the severity of preeclampsia (P<0.001). Platelet distribution width (rho = 0.731, p<0.001) and mean platelet volume (rho = 0.674, p<0.001) had statistically significant positive relationships with mean arterial pressure. The best metric for predicting preeclampsia was platelet distribution width (AUC = 0.986; 95%CI; 0.970, 1). Platelet indices, including platelet count, mean platelet volume, platelet distribution width, and Platelet crit, have been identified as promising candidate markers for predicting preeclampsia in pregnant women. In the future, a serial examination of these indicators during several trimesters of pregnancy should be conducted.

Association between ovarian reserve and preeclampsia: a cohort study

BackgroundThe risk of cardiovascular disease in women increases after menopause. It has been shown that women with lower pre-menopausal ovarian reserve may experience increased cardiovascular risk. We sought to determine whether there is any association between ovarian reserve, as assessed by Anti-Mullerian hormone (AMH), and preeclampsia (PE).MethodsSubjects of this study were selected from among participants of the Tehran Lipid and Glucose Study (TLGS), a population-based cohort with a 15-year follow-up (1998–2014). Out of 2412 women aged 20–50 years, there were 781 women who met eligibility criteria, including having comprehensive data on their reproductive assessment and ovarian reserve status, identified based on age-specific AMH levels according to the exponential–normal three-parameter model that was measured before pregnancy.There were 80 and 701 participants in the preeclampsia and non-PE groups, respectively. The association between dichotomous outcome variable PE and age-specific AMH quartiles was evaluated using pooled logistic regression.ResultsPE was observed in 23 (11.1%), 12 (6.4%), 26 (13.3%) and 19 (10%) women in the 1st, 2nd, 3rd and 4th quartiles of pre-pregnancy age-specific AMH, respectively (P = 0.16). Median and inter-quartile range of serum AMH levels was 1.05 (0.36–2.2) mg/L in women who experienced PE compared with 0.85 (0.28–2.1) mg/L in women with normotensive pregnancies (P = 0.53). Based on the pooled logistic regression analysis, the effect of age-specific AMH quartiles on PE progression (adjusted for age, BMI, smoking status, and family history of hypertension) were not significant (OR1st vs 4th: 1.5, P-value: 0.1, CI: (0.9, 2.4)).ConclusionsAge-specific AMH may not be a suitable marker for prediction of PE. Further longitudinal studies, considering pre-conception measurement of AMH, are recommended for better interpretation of the association between ovarian reserve status and PE.

Comparison of mean platelet volume (MPV) and sFlt-1/PlGF ratio as predictive markers for preeclampsia

Introduction Preeclampsia is characterised by an increased platelet consumption with consecutive reduction of overall platelet count and a consecutive rise in mean platelet volume (MPV). MPV has therefore been suggested as a predictive marker for preeclampsia. We aimed to investigate MPV longitudinally in women with preeclampsia compared to healthy controls during pregnancy for potential early detection of preeclampsia and to compare potential MPV changes against the sFlt-1/PlGF ratio. Study design This longitudinal study included 38 women with preeclampsia and 84 women with normal pregnancies, where MPV and sFlt-1 and PLGF levels were determined every 4 weeks, starting in early pregnancy. Results MPV was significantly higher in women who developed preeclampsia compared to women with normal pregnancies at 12, (p = .029), 24 (p = .011), 28 (p = .037), 32 (p = .002), and 36 weeks of gestation, respectively (p = .015). Further analysis revealed a cut-off point of 10.85 fl (sensitivity 65.6%, specificity 26.2%) for the prediction of preeclampsia. The sFlt-1/PlGF ratio was significantly higher in women who developed preeclampsia compared to women with normal pregnancies at the same time points (p = .001). The cut-off point for predicting preeclampsia was 10.3 (sensitivity 87.5%, specificity 11.9%). ROC curve analysis showed that MPV has a high predictive value for early-onset preeclampsia (p < .05) but not for late-onset preeclampsia. Conclusion MPV is significantly elevated even in early pregnancy in women who develop preeclampsia and seems, therefore, a valuable predictor for preeclampsia even at early gestation. However, according to our results, MPV seems reliable in predicting early onset preeclampsia.

Biochemical markers in prediction of pre-eclampsia

Biochemical markers in prediction of pre-eclampsia

Potential role of serum homocysteine and uric acid level as a predictive marker for pre-eclampsia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hypertension is one of the common disorders during pregnancy and can cause severe health complications for both mother and developing fetus. Pre-eclampsia (PE) is a form of hypertensive disorder complicating pregnancy. This study was aimed to estimate serum uric acid and homocysteine level as a potential biomarker for prediction of preeclampsia.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 85 pre-eclamptic pregnant women and 50 normotensive pregnant women were recruited from department of Obstetrics and Gynecology, Star Hospital after obtaining the informed written consent. Blood samples were collected and analyzed for serum homocysteine and serum uric acid level. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Serum uric acid and homocysteine levels were found to be significantly higher in pre-eclamptic cases than in controls (6.5±0.7 mg/dl and 13.5±5.4 µmol/l in cases versus 4.3±0.8 mg/dl and 10.1±4.6 µmol/l in healthy controls). Maximum sensitivity and specificity of serum uric acid was obtained at a cut-off of 5.5 mg/dl (sensitivity- 91% and Specificity- 88%) and serum homocysteine at 10.7 µmol/l (sensitivity-67% and specificity-64%) respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; At optimum cut off value serum uric acid showed highest sensitivity and specificity for diagnosis of pre-eclampsia. Thus, serum uric acid level is better predictive marker compared to serum homocysteine level for pre-eclampsia.&lt;/p&gt;

Neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and c-reactive protein as markers for severity of pre-eclampsia

Objective In this study , we aimed to compare and correlate neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein (CRP) levels in patients with different degrees of pre-eclampsia (PE). Patients and methods We recruited 105 Egyptian pregnant women with gestational age more than or equal to 34 weeks. They were divided into 35 normotensive pregnant women and 70 pre-eclamptic women and were further subdivided into 35 mild and 35 severe PE cases according to the American College of Obstetricians and Gynecologists criteria. Results There was no statistically significant difference between patients with PE and healthy pregnant women regarding NLR. PLR showed a statistically significant difference between the control and severe PE cases and between mild and severe PE cases. CRP levels showed statistically significant difference between the control and mild PE cases and between the control and severe PE cases. Conclusion CRP was more sensitive and specific than PLR to predict PE in pregnant women, so it can be used in prediction of PE. PLR was more sensitive but less specific than CRP to predict severity of PE in pregnant women, so PLR can be used for early prediction of severity. NLR cannot be used as a marker for prediction of PE or its severity.

Microalbuminuria as an early predictor of preeclampsia in the pre-gestational diabetic population: A prospective cohort study.

To determine if microalbuminuria can be used as a predictive marker of preeclampsia and adverse pregnancy and neonatal outcomes in women with pre-existing diabetes and to compare the prognostic utility of urinary albumin to creatinine ratio (uACR) and urinary protein to creatinine ratio (uPCR). Multicentre prospective cohort study. Antenatal Diabetes in Pregnancy clinics at three tertiary referral hospitals in Western Sydney, Australia. 158 women with pre-existing diabetes requiring insulin in pregnancy. A spot uPCR and uACR was performed in each trimester. Pregnancy and fetal outcomes were investigated using linear models and receiver-operating characteristic (ROC) curves. The primary outcome was preeclampsia (PE). Secondary outcomes investigated were other adverse pregnancy and neonatal outcomes. Increased levels of both uPCR and uACR in trimester 3 were associated with the occurrence of PE (p = 0.007, 0.010 respectively). In the 113 patients with normal pregnancy uPCR (<30 mg/mmol) in trimester 1, microalbuminuria was found to be predictive of PE (p = 0.01) and need for operative delivery (p = 0.03). In women with pre-existing diabetes, uPCR and uACR appear to have similar ability to diagnose PE, but microalbuminuria demonstrates prognostic ability at a much earlier gestation, prior to the onset of other signs or symptoms of PE. We therefore suggest that assessing microalbuminuria rather than overt proteinuria in trimester 1 provides prognostic information in women with pre-existing diabetes requiring insulin and should be used routinely to evaluate risk of PE in this high-risk cohort of women.

The soluble fms-like tyrosin kinase-1 (sFLT-1) to placental growth factor (PIGF) ratio as a possible indicator for the severity of preeclampsia - single institution experience.

Aim To investigate a potential of the clinical use of the soluble fms-like tyrosine kinase 1 (sFLT-1) to placental growth factor (PlGF) ratio from the perspective of a small hospital centre. Methods Maternal serum samples were analysed at 241/7-28 0/7, and 281/7-320/7 weeks of gestation. The level of sFLT-1 and PIGF was determined by immunoassay platform and used to calculate the sFLT-1/PIGF ratio in 35 pregnant women, and divided into subgroups according to preeclampsia occurrence at the time of delivery: preterm (≤37 weeks) or term (37-42 weeks'), and matched a control group. Results Patients in the preterm delivery group had a significantly higher incidence of intrauterine growth restriction, lower gestational age at the time of delivery, and lower infant birth weight compared to the other two groups. There was a negative correlation between the sFLT-1/PlGF ratio and GA and between the sFLT-1/ PlGF ratio and birth weight at the time of delivery. The value of the sFLT-1/PlGF ratio was significantly higher in the preterm delivery PE group. All the PE group pregnancies ended with caesarean delivery compared to 25% in the control group. However, none of the patients from the PE group had any of the possible complications of preeclampsia nor did they require additional therapy such as blood transfusion or additional non-standard hypertensive therapy. Conclusion The sFLT-1/PlGF ratio could be used as an indicator for the development and estimation of the severity of PE to provide objective evidence for the management of preeclampsia patients, and as a predictive marker of preeclampsia at low cost.

First versus second trimester mean platelet volume and uric acid for prediction of preeclampsia in women at moderate and low risk

ABSTRACT Objective: To determine if second trimester mean platelet volume (MPV) and serum uric acid are reasonable predictors of preeclampsia (PE) or not, in patients at moderate and low risk. Methods: This prospective study was conducted on 9522 women at low or moderate risk for developing PE who underwent dual measurements of MPV and serum uric acid at late first trimester (10–12 weeks) and at second trimester (18–20 weeks) and subsequently divided into two groups; PE group (n = 286) who later developed PE and non-PE group (n = 9236). Test validity of MPV and serum uric acid was the primary outcome measure. Data were collected and analyzed. Results: Second trimester MPV is a good predictor for development of PE at a cutoff value of 9.55 fL with area under the curve (AUC) of 0.86, sensitivity of 95.2%, specificity of 66.7%, positive predictive value (PPV) of 87%, negative predictive value (NPV) of 85.7%, and accuracy of 86.7%. Second trimester serum uric acid is a good predictor for development of PE at a cutoff value of 7.35 mg/dL, with AUC of 0.85, sensitivity of 95.2%, specificity of 55.6%, PPV of 83.3%, NPV of 83.3%, and accuracy of 83.3%. Combination of both tests has a sensitivity of 100%, specificity of 22.2%, PPV of 75%, NPV of 100%, and accuracy of 76.7%. Conclusion: Second trimester MPV and serum uric acid alone or in combination could be used as a useful biochemical markers for prediction of PE based on their validity, simplicity, and availability.

Clinical significance of platelet-to-lymphocyte ratio in women with preeclampsia.

Preeclampsia (PE) is a serious pregnancy complication leading to high maternal, perinatal morbidity, and mortality. We aimed to investigate the clinical effectiveness of the platelet-to-lymphocyte ratio (PLR) in women with PE and compare this measurement to platelet indices as a diagnostic and prognostic marker of PE. A total of 471 healthy pregnant women, 126 women diagnosed with mild PE, and 227 with severe PE were included in this retrospective study. We analyzed PLR and platelet indices, mainly mean platelet volume (MPV) and platelet distribution width (PDW) among the 3 groups. Platelet distribution width, MPV, and PLR levels in women with PE were significantly different from those of healthy pregnant women. PLR was significantly lower in severe PE than mild PE (P=.001), but PDW and MPV increased as severity of PE progressed; however, the differences in PDW and MPV between women with mild and severe PE were not significant. Receiver operating characteristic curve analysis showed that PLR was more predictive of PE than PDW and MPV (Area under the curve=0.759 vs 0.621, 0.638). Additionally, the time interval from admission to delivery was significantly shorter in women with PLR-positive (≤116) than in women with PDW-positive (>58) and MPV-positive (>9). The PLR is an easily accessible and cost-effective parameter, which may be used as a more useful marker for prediction of PE compared to platelet indices. Our study showed that PLR can serve as a useful diagnostic marker of PE.

The sFlt-1/PlGF ratio as a predictor for poor pregnancy and neonatal outcomes

Soluble fms-like tyrosine kinase receptor-1 (sFlt-1)/placental growth factor (PlGF) ratio has been studied extensively as a predictive marker for pre-eclampsia. However, its usefulness for predicting neonatal outcomes remains unknown. This study aimed to evaluate the association of sFlt-1/PlGF ratio with pregnancy outcomes, neonatal morbidities and short-term postnatal growth patterns in pregnant women and their babies. sFlt-1 and PlGF were measured in women with fetal intrauterine growth retardation (IUGR) or pre-eclampsia during gestational age (GA) of 16-36 weeks. These women were classified into high- and low-ratio groups with a sFlt-1/PlGF cut-off ratio of 85. The maternal and neonatal outcomes were retrospectively reviewed and compared between the two groups. A total of 25 pregnant women were recruited. Thirteen of them had a sFlt-1/PlGF ratio over 85 and twelve had a ratio of less than 85. The median duration from elevation of sFlt-1/PlGF to delivery was 4.5 weeks. Women in the high SFlt-1/PlGF ratio group had higher rates of intrauterine fetal demise (2/13 vs. 0/12) and early termination (1/13 vs. 0/12). The surviving offspring in this group had a higher incidence of preterm birth (GA: 31.4±2.9 weeks vs. 37.3±1.3 weeks, p<0.001), lower birth weight (1142±472g vs. 2311±236g, p<0.001), higher incidence of respiratory distress syndrome (6/10 vs. 0/12, p=0.002) and bronchopulmonary dysplasia (4/10 vs. 0/12, p=0.01). However, the percentile of body weight, height and head circumference at 28 days of age, 56 days of age and the corrected age of 6 months were comparable between groups. High sFlt-1/PlGF ratio in pregnant women is associated with poor pregnancy and neonatal outcomes. Therefore, the monitoring of sFlt-1/PlGF ratio in pregnant women with fetal IUGR and timely management for placenta-associated diseases are recommended.

Clinical and Biochemical Markers for Prediction of Preeclampsia

Clinical and Biochemical Markers for Prediction of Preeclampsia

Clinical and Biochemical Markers for Prediction of Preeclampsia

Clinical and Biochemical Markers for Prediction of Preeclampsia

The Level of Serum and Urinary Nephrin in Normal Pregnancy and Pregnancy with Subsequent Preeclampsia

PurposeThe aim of this study was to evaluate serum and urinary nephrin levels of normal pregnancy to establish a standard reference value and to compare them with patients who subsequently developed preeclampsia (PE).Materials and MethodsIn this prospective study, 117 healthy singleton pregnancies were enrolled between 6 to 20 weeks of gestation at 2 participating medical centers during October 2010 to March 2012. Urine and serum samples were collected at the time of enrollment, each trimester, and at 4 to 6 weeks postpartum. Enzyme-linked immunosorbent assay for nephrin was performed and samples from patients who subsequently developed PE were compared to the normal patients.ResultsOf 117 patients initially enrolled, 99 patients delivered at the study centers and of those patients, 12 (12.1%) developed PE at a median gestational age of 34+4 weeks (range 29+5–36+6). In the normal patients (n=68), serum nephrin level decreased and urinary nephrin level increased during the latter of pregnancy. In 12 patients who subsequently developed PE, a significant rise in the 3rd trimester serum and urinary nephrin levels, compared to the controls, was observed (p<0.001), and this increase occurred 9 days prior to the onset of clinical disease.ConclusionAs the onset of PE was preceded by the rise in the serum and urinary nephrin in comparison to normal pregnancy, serum and urinary nephrin may be a useful predictive marker of PE.

Complement component C1q as potential diagnostic but not predictive marker of preeclampsia.

We have previously found that C1q is constitutively expressed by invading trophoblast and endothelial cells of decidua and contributes to vascular and tissue remodeling. Based on these findings, we sought to determine whether there were changes in the circulating level of C1q that may be used as a diagnostic and predictive marker of preeclampsia. We measured the levels of C1q, C4, and complement activation products in serum or plasma of normal pregnant women and preeclamptic patients from different cohorts. We observed a marked decrease in the concentration of C1q associated with a reduced level of C4 in preeclamptic patients as compared to matched healthy pregnant woman but no significant difference in the circulating level of the activating products C5a and the soluble terminal complement complex sC5b-9. Analysis of serum samples collected at early phase of pregnancy from women who later developed preeclampsia failed to show a decrease in C1q level. The results of the present investigation demonstrate that low levels of C1q and C4 are associated with preeclampsia but cannot be used as predictive markers.

First Trimester Screening for Preeclampsia and Intrauterine Growth Restriction Using Uterine Artery Doppler and Maternal Serum Placental Growth Factor and Pregnancy Associated Plasma Protein- A

Objective: To assess the accuracy of first-trimester uterine artery Doppler indices combined with maternal serum placental growth factor (PlGF) and pregnancy associated plasma protein- A (PAPP-A) in the prediction of preeclampsia (PE) and intrauterine growth restriction (IUGR) in low risk pregnancy. Design: Prospective observational study. Patients and methods: A total of 266 low risk singleton pregnant women at12-14 weeks’ gestation were recruited and completed the study. Uterine artery (UtA) color Doppler study was estimated on the two sides, the mean pulsatility index (PI) was calculated and dicrotic diastolic notches were recorded. Estimation of maternal serum PlGF and PAPP-A were performed on the same day. The cut-off of Ut Ar PI was 2.35, the cut-off of PlGF was 12pg/ml and the cut off of PAPP-A was 0.42 MoM. The patients were followed up to detect PE and IUGR. PE developed in 14 cases (5.26 %), 2 cases early-onset 2 cases and late-onset 12 cases and IUGR in 19 cases (7.14 %), early-onset 3 cases and late-onset 16 cases. The sensitivity, specificity, positive and negative value (PPV and NPV) and accuracy were calculated. The higher sensitivity and PPV and accuracy for prediction of PE and IUGR were found when first trimester UtA PI and PlGF were combined. The addition of PAPR-A did not improve the accuracy. Conclusion: The ideal first trimester markers for prediction of PE and IUGR in low risk pregnant women may be a combination of UtA PI and maternal serum PlGF.

Combined Screening for Early Detection of Pre-Eclampsia.

Although the precise pathophysiology of pre-eclampsia remains unknown, this condition continues to be a major cause of maternal and fetal mortality. Early prediction of pre-eclampsia would allow for timely initiation of preventive therapy. A combination of biophysical and biochemical markers are superior to other tests for early prediction of the development of pre-eclampsia. Apart from the use of parameters in first-trimester aneuploidy screening, cell-free fetal DNA quantification is emerging as a promising marker for prediction of pre-eclampsia. This article reviews the current research of the most important strategies for prediction of pre-eclampsia, including the use of maternal risk factors, mean maternal arterial pressure, ultrasound parameters, and biomarkers.