Screening Test For Preeclampsia Research Articles

Prediction of pre-eclampsia, low birthweight for gestation and prematurity by uterine artery blood flow velocity waveforms analysis in low risk nulliparous women.

To assess the performance of four previously reported Doppler abnormalities of uterine artery velocity waveforms (presence of a protodiastolic notch, peak systolic over protodiastolic velocities (A:C ratio) > 2.5, peak systolic over end diastolic velocities (A:B ratio) > 90th centile, resistance index (RI) ([A-B]/A) > or = 0.58) in predicting pre-eclampsia, low birthweight and prematurity. Prospective cohort study. Tertiary care university hospital in Quebec City. 1311 nulliparous women. Evaluation of pulsed Doppler abnormalities of uterine artery velocity waveforms was carried out in 1000 and 1194 of women at 18.3 (SD 0.9) or 26.7 (SD 0.9) weeks of pregnancy. Pre-eclampsia, birthweight below the 10th centile for gestational age and spontaneous preterm birth (< 37 completed gestation weeks). Pre-eclampsia, low birthweight for gestation and prematurity occurred in 4%, 11% and 7% of the pregnancies, respectively. At 26 weeks all the abnormalities of the studied Doppler indices were significantly associated with pre-eclampsia and low birthweight for gestation as reflected by the 95% confidence intervals of the positive likelihood ratios which did not include the value 1. However, sensitivities (26% to 34%) and positive predictive values (7% to 28%) were low. No Doppler indices performed significantly better than the others. The abnormalities of the Doppler indices were not associated with spontaneous prematurity. The performance of the Doppler measurements performed at 18 weeks was poor. Uterine artery Doppler velocimetry waveform analysis does not qualify as a reliable screening test for pre-eclampsia or low birthweight for gestation in low risk pregnancies but may be useful in selected high risk populations.

The value of elevated second-trimester β-human chorionic gonadotropin in predicting development of preeclampsia

OBJECTIVE: Our purpose was to investigate the association of an elevated second-trimester serum β-human chorionic gonadotropin concentration with the subsequent development of hypertension in pregnancy and to evaluate its utility as a screening test for preeclampsia. STUDY DESIGN: We examined 6286 nondiabetic women with singleton pregnancies who, as part of triple-screen testing, had a serum β human chorionic gonadotropin level drawn between 15 and 22 weeks' gestation between November 1, 1991, and November 30, 1994. Medical records of women with hypertension ( n = 675) were reviewed, patients with chronic hypertension were excluded, and the remainder were classified as having gestational hypertension ( n = 333), mild preeclampsia ( n = 110), or severe preeclampsia ( n = 84). The β-human chorionic gonadotropin level expressed as multiples of the median adjusted for maternal weight and gestational age was compared between normotensive and hypertensive complicated pregnancies. RESULTS: In the overall population β-human chorionic gonadotropin levels ≥2.0 multiples of the median during the second trimester were significantly associated with development of hypertension in pregnancy. The rate ratio for development of overall hypertension was 1.6 (95% confidence interval 1.3 to 2.0) and for preeclampsia 1.8 (95% confidence interval 1.3 to 2.6). When stratified by parity, a statistically significant association remained only among multiparous women, for overall hypertension (rate ratio 2.2, 95% confidence interval 1.6 to 3.2) and for preeclampsia (rate ratio 3.4, 95% confidence interval 2.1 to 5.6). Adjusting for confounding factors did not alter the results. In the overall population, with the use of 2.0 multiples of the median of β-human chorionic gonadotropin as a cutoff value, the sensitivity of β-human chorionic gonadotropin as a screen for development of hypertension was 15.6%, the specificity was 90.0%, and the positive predictive value was 12.8%. CONCLUSION: Overall, second-trimester serum β-human chorionic gonadotropin levels were elevated among women who had hypertension during pregnancy. In our population this association was statistically significant only among multiparous women. The utility of an elevated second-trimester β-human chorionic gonadotropin level as a screening test for preeclampsia is limited.(Am J Obstet Gynecol 1997;176:438-42.)

Pregnancy hypertension and uterine artery Doppler ultrasound

The application of uterine artery Doppler velocimetry as a screening test for pre-eclampsia and other adverse pregnancy complications is still considered a research tool by most obstetricians. Increasing use of colour Doppler ultrasound has allowed a better understanding of pathophysiological changes in the uterine circulation. This in turn has refocused attention on the potential use of uterine artery Doppler velocimetry as part of our antenatal screening strategy. This review summarizes the most recent work surrounding the application of this test as a screening test for pre-eclampsia.

The angiotensin sensitivity test and low-dose aspirin are ineffective methods to predict and prevent hypertensive disorders in nulliparous pregnancy

OBJECTIVE: Our purpose was to assess the efficiency of the angiotensin sensitivity test as a predictive test for preeclampsia and the effectiveness of low-dose aspirin to prevent preeclampsia when commenced at 28 weeks' gestation in angiotensin II-sensitive women. STUDY DESIGN: A total of 495 healthy nulliparous women underwent the angiotensin sensitivity test at 28 weeks' gestation. The angiotensin II-sensitive women were randomized to 60 mg of aspirin or placebo as a subset of a large multicenter, randomized, controlled trial of low-dose aspirin therapy in pregnancy. Assessment of the efficiency of the angiotensin sensitivity test and low-dose aspirin in pregnancy was performed after detailed review of case notes after delivery. The Oxford definition of preeclampsia was used. This includes women without proteinuria but requirs blood pressure increments that have been validated to bias the selection to primigravid women. RESULTS: Five women had proteinuric preeclampsia in the angiogensin II-sensitive group randomized to aspirin compared with none in the group randomized to placebo. Overall, 11 (25%) of the women randomized to aspirin had preeclampsia compared with four (11%) randomized to placebo ( p > 0.05, not significant). The positive and negative predictive values for the angiotensin sensitivity test were 19% and 87%, respectively. CONCLUSION: The angiotensin sensitivity test is not an effective screening test for preeclampsia, and low-dose aspirin does not prevent preeclampsia when commenced at 28 weeks' gestation in angiotensin II-sensitive women.

Performance of Doppler ultrasonography as a screening test in low risk pregnancies: results of a multicentric study.

To assess the efficacy of the Doppler velocimetry of the uterine and umbilical arteries as a screening test for preeclampsia and fetal growth retardation, we studied 916 low risk pregnancies. The S/D ratios of the uterine and umbilical arteries were obtained at 19 to 24 weeks and at 26 to 31 weeks of gestational age. Mean values, receiver operator curves, and the diagnostic accuracy of the tests were calculated for the following end-points: (1) pregnancy-induced hypertension, (2) low birth weight for gestational age, (3) small for gestational age with abnormal outcome, (4) pregnancy-induced hypertension needing preterm delivery. The prevalences for these outcomes were 3.4%, 4.6%, 1%, and 0.7%, respectively. The study was blinded. The umbilical and uterine artery S/D ratios were significantly higher in the abnormal than in the normal outcome group. When uterine arteries were studied at 19 to 24 weeks, sensitivity was 59% in the detection of pregnancy-induced hypertension, 11% in the detection of small for gestational age fetuses, 33% in the detection of small for gestational age fetuses with abnormal outcome, and 83% in the detection of pregnancy induced hypertension needing preterm delivery; the corresponding values for specificity were 69%, 94%, 94%, and 68%. At 26 to 31 weeks the sensitivity values were respectively, 69%, 58%, 75%, and 100% and specificity values were 80%, 59%, 39%, and 79%. When umbilical arteries were studied at 19 to 24 weeks, sensitivity was 38% in the detection of pregnancy-induced hypertension, 46% in the detection of small for gestational age fetuses, 78% in the detection of small for gestational age fetuses with abnormal outcome, and 67% in the detection of pregnancy-induced hypertension needing preterm delivery. The corresponding values of specificity were 74% for all four groups. At 26 to 31 weeks the sensitivity values were 38%, 43%, 87%, and 67%, respectively, and specificity values were 80% for all four groups. We concluded that Doppler examinations of the uterine and umbilical arteries can detect, at midpregnancy, the severe forms of pregnancy-induced hypertension and small for gestational age fetuses but they cannot be used to screen a low risk population in which the prevalence of the disease is low, and hence the positive predictive value is low.

Utility of a Single Plasma Fibronectin Level for the Prediction of Preeclampsia

Previous studies have indicated that repeated maternal plasma fibronectin (FN) levels may aid in the prediction of preeclampsia. To investigate the development of a preeclampsia screening test, avoiding the requirement for repeated maternal blood samples throughout pregnancy, we examined the efficacy of a single screening plasma FN level for the prediction of preeclampsia. Total plasma FN levels were determined between 24 and 32 weeks' gestation in 115 normotensive patients, and cellular FN was determined in a subgroup of 81 of these patients. Among nulliparas (n = 76) total plasma FN values were significantly (P = 0.007) greater in patients (n = 13) who subsequently developed preeclampsia (median = 370, range 130-1104 μg/ml) than among those who remained nonpreeclamptic (median = 283, range 80-490 μg/ml). Based on maximization of the receiver/operator curve, a cut-off plasma FN value of 300 μg/ml was selected as a positive screen in the nulliparous group, resulting in a sensitivity of 85%, specificity of...

Second trimester ambulatory blood pressure in nulliparous pregnancy: a useful screening test for pre-eclampsia?

Objective To assess the effectiveness of second trimester 24-hour ambulatory blood pressure measurement as a screening test for pre-eclampsia. Design Prospective interventional study. Setting John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London. Subjects One hundred and sixty-two normotensive nulliparous women recruited at hospital booking clinics. Intervention Ambulatory blood pressure was measured at 18 and 28 weeks gestation using the TM2420 monitor. Main outcome measure The development of pre-eclampsia. Results Awake systolic and mean arterial pressures were significantly increased (P<0.02) at 18 weeks in those who later developed pre-eclampsia. Those differences were more apparent at 28 weeks at which time the diastolic pressure was also increased (P<0.01). At both stages of gestation the higher readings were sustained during sleep so that the awake-sleep differences were similar in relation to each outcome. The group with incipient pre-eclampsia had a significantly faster heart rate at both 18 and 28 weeks (P<0.002) The sensitivity in predicting pre-eclampsia for a mean arterial pressure of 85 mmHg or greater at 28 weeks was 65%, with a positive predictive value of 31 %. The sensitivity and positive predictive value for a test combining a mean arterial pressure of 85 mmHg or greater and a heart rate of 90 bpm or greater were 53% and 45%, respectively. Conclusion Although second trimester ambulatory blood pressure is significantly increased in women who later develop pre-eclampsia, the predictive values for blood pressure alone are low. The efficiency of the test is increased by combining the awake ambulatory heart rate and blood pressure measurement together. If an effective method for preventing pre-eclampsia becomes available (commencing at 28 weeks gestation), then awake ambulatory blood pressure and heart rate may have some clinical value as a screening test.

Second trimester ambulatory blood pressure in nulliparous pregnancy: A useful screening test for preeclampsia?

International Journal of Gynecology & ObstetricsVolume 46, Issue 1 p. 84-84 Citations from the literature diseases in pregnancy Second trimester ambulatory blood pressure in nulliparous pregnancy: A useful screening test for preeclampsia? P.M. Kyle, P.M. KyleSearch for more papers by this authorS.J. Clark, S.J. ClarkSearch for more papers by this authorD. Buckley, D. BuckleySearch for more papers by this authorJ. Kissane, J. KissaneSearch for more papers by this authorA.J.S. Coats, A.J.S. CoatsSearch for more papers by this authorM. De Swiet, M. De SwietSearch for more papers by this authorC.W.G. Redman, C.W.G. RedmanSearch for more papers by this author P.M. Kyle, P.M. KyleSearch for more papers by this authorS.J. Clark, S.J. ClarkSearch for more papers by this authorD. Buckley, D. BuckleySearch for more papers by this authorJ. Kissane, J. KissaneSearch for more papers by this authorA.J.S. Coats, A.J.S. CoatsSearch for more papers by this authorM. De Swiet, M. De SwietSearch for more papers by this authorC.W.G. Redman, C.W.G. RedmanSearch for more papers by this author First published: July 1994 https://doi.org/10.1016/0020-7292(94)90320-4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume46, Issue1July 1994Pages 84-84 RelatedInformation

Second trimester ambulatory blood pressure in nulliparous pregnancy: a useful screening test for pre-eclampsia?

To assess the effectiveness of second trimester 24-hour ambulatory blood pressure measurement as a screening test for pre-eclampsia. Prospective interventional study. John Radcliffe Maternity Hospital, Oxford, and Queen Charlotte's and Chelsea Hospital, London. One hundred and sixty-two normotensive nulliparous women recruited at hospital booking clinics. Ambulatory blood pressure was measured at 18 and 28 weeks gestation using the TM2420 monitor. The development of pre-eclampsia. Awake systolic and mean arterial pressures were significantly increased (P < 0.02) at 18 weeks in those who later developed pre-eclampsia. Those differences were more apparent at 28 weeks at which time the diastolic pressure was also increased (P < 0.01). At both stages of gestation the higher readings were sustained during sleep so that the awake-sleep differences were similar in relation to each outcome. The group with incipient pre-eclampsia had a significantly faster heart rate at both 18 and 28 weeks (P < 0.002) The sensitivity in predicting pre-eclampsia for a mean arterial pressure of 85 mmHg or greater at 28 weeks was 65%, with a positive predictive value of 31%. The sensitivity and positive predictive value for a test combining a mean arterial pressure of 85 mmHg or greater and a heart rate of 90 bpm or greater were 53% and 45%, respectively. Although second trimester ambulatory blood pressure is significantly increased in women who later develop pre-eclampsia, the predictive values for blood pressure alone are low. The efficiency of the test is increased by combining the awake ambulatory heart rate and blood pressure measurement together. If an effective method for preventing pre-eclampsia becomes available (commencing at 28 weeks gestation), then awake ambulatory blood pressure and heart rate may have some clinical value as a screening test.

The prediction of pre-eclampsia

The development of prophylactic therapy which prevents the development of pre-eclampsia has increased the potential application of any predictive test. However, as yet there is no practical, acceptable and reliable screening test for pre-eclampsia that has been thoroughly tried and tested. The AII sensitivity test, widely regarded as the most reliable predictive test for pre-eclampsia is patently unsuitable as a mass screening test. However, there are several techniques which may prove to be appropriate screening tests. This review considers the tests listed in the Table. The most promising are the hand-grip test, plasma levels of fibronectin, measurement of platelet AII binding and doppler ultrasound with colour flow imaging.