van der Tuuk Karin, Koopmans Corine M, Groen Henk, Aarnoudse Jan G, van den Berg Paul P, van Beek Johannes J, Copraij Frans J A, Kleiverda Gunilla, Porath Martina, Rijnders Robbert J P, van der Salm Paulien C M, Santema Job G, Stigter Robert H, Mol Ben W J, van Pampus Maria G
Department of Obstetrics and Gynecology, University Medical Centre Groningen, Groningen, The Netherlands.
Aust N Z J Obstet Gynaecol. 2011 Aug;51(4):339-46. doi: 10.1111/j.1479-828X.2011.01311.x. Epub 2011 Apr 18.
To evaluate whether progression to a high-risk situation is predictable in women with gestational hypertension (GH) or mild pre-eclampsia (PE) at term.
Women with a singleton pregnancy, a fetus in cephalic position, between 36 and 41 weeks of gestation, complicated by GH or mild PE that were managed expectantly, were selected from the HYPITAT trial. We evaluated the predictability of progression to a high-risk situation. Logistic regression was used to determine the predictive value of clinical characteristics or laboratory findings and to generate a prediction model for progression to a high-risk situation. The predictive value of this model was assessed with receiver-operating characteristic (ROC) analysis, calibration and internal validation.
We included 703 women, of whom 244 (34.7%) had progression to a high-risk situation. After multivariable analysis, nulliparity (OR 1.87), maternal age (OR 1.05 per year), gestational age (OR 0.88 per week), previous abortion (OR 1.26), ethnicity (OR 2.05 for non-Caucasian ethnicity), diastolic (OR 1.04 per mmHg), systolic blood pressure (OR 1.02 per mmHg) and the laboratory parameters proteinuria, haemoglobin, platelets, uric acid and alanine aminotransferase were included in the final model. The area under the ROC curve of this model was 0.71 (95% CI, 0.67-0.74). Even though the goodness of fit was moderate (P=0.40), internal validation showed the model could hold in the overall population.
In the prediction of progression to a high-risk situation, in women with GH or mild PE at term, a distinction can be made between women with a low risk and women with high risk.
评估足月妊娠合并妊娠期高血压（GH）或轻度子痫前期（PE）的女性进展为高危情况是否可预测。
从HYPITAT试验中选取单胎妊娠、头位胎儿、妊娠36至41周、合并GH或轻度PE且接受期待治疗的女性。我们评估了进展为高危情况的可预测性。采用逻辑回归确定临床特征或实验室检查结果的预测价值，并生成进展为高危情况的预测模型。通过受试者工作特征（ROC）分析、校准和内部验证评估该模型的预测价值。
我们纳入了703名女性，其中244名（34.7%）进展为高危情况。多变量分析后，未生育（比值比1.87）、产妇年龄（每年比值比1.05）、孕周（每周比值比0.88）、既往流产史（比值比1.26）、种族（非白种人种族比值比2.05）、舒张压（每mmHg比值比1.04）、收缩压（每mmHg比值比1.02）以及实验室参数蛋白尿、血红蛋白、血小板、尿酸和丙氨酸转氨酶被纳入最终模型。该模型的ROC曲线下面积为0.71（95%可信区间，0.67 - 0.74）。尽管拟合优度中等（P = 0.40），但内部验证表明该模型在总体人群中适用。
在预测足月妊娠合并GH或轻度PE的女性进展为高危情况时，可以区分低风险和高风险女性。
