Wright D, Dragan I, Syngelaki A, Akolekar R, Nicolaides K H
Institute of Health Research, University of Exeter, Exeter, UK.
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Ultrasound Obstet Gynecol. 2017 Feb;49(2):194-200. doi: 10.1002/uog.17309.
To estimate the patient-specific risk of pre-eclampsia (PE) at 30-34 weeks' gestation by a combination of maternal characteristics and medical history with multiples of the median (MoM) values of mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1), and stratify women into high-, intermediate- and low-risk management groups.
This was a prospective observational study in women attending a third-trimester ultrasound scan at 30-34 weeks as part of routine pregnancy care. Patient-specific risks of delivery with PE at < 4 weeks from assessment and at < 40 weeks' gestation were calculated using the competing-risks model to combine the prior risk from maternal characteristics and medical history with MoM values of MAP, UtA-PI, PlGF and sFlt-1. On the basis of these risks, the population was stratified into high-, intermediate- and low-risk groups. Different risk cut-offs were used to vary the proportion of the population stratified into each risk category and the performance of screening for delivery with PE at < 4 weeks from assessment and delivery with PE from 4 weeks after assessment and up to 40 weeks' gestation was estimated.
The study population of 8128 singleton pregnancies included 234 (2.9%) that subsequently developed PE. Using a risk cut-off of 1 in 50 for PE delivering at < 4 weeks and a risk cut-off of 1 in 150 for PE delivering at < 40 weeks' gestation, the proportion of the population stratified into high, intermediate and low risk was about 3%, 26% and 71%, respectively. The high-risk group contained 90% of pregnancies with PE at < 4 weeks and 40% of those with PE at 4 weeks from assessment to 40 weeks' gestation. The intermediate-risk group contained a further 49% of women with PE at 4 weeks from assessment to 40 gestational weeks. In the low-risk group, none of the women developed PE at < 4 weeks and only 0.3% developed PE at 4 weeks to 40 gestational weeks.
The study presents risk stratification of PE by the combined test at 30-34 weeks, aiming to identify a high-risk group in need of intensive monitoring from the time of the initial assessment and up to 40 weeks' gestation and an intermediate-risk group in need of monitoring from 4 weeks after the initial assessment and up to 40 weeks' gestation. All pregnancies would need to be reassessed at 40 weeks' gestation. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
通过将孕妇特征和病史与平均动脉压（MAP）、子宫动脉搏动指数（UtA-PI）、血清胎盘生长因子（PlGF）及血清可溶性fms样酪氨酸激酶-1（sFlt-1）的中位数倍数（MoM）值相结合，评估孕30 - 34周时子痫前期（PE）的个体特异性风险，并将女性分为高、中、低风险管理组。
这是一项前瞻性观察性研究，研究对象为在孕30 - 34周进行孕晚期超声扫描的孕妇，作为常规孕期保健的一部分。使用竞争风险模型计算评估后<4周及<40周妊娠时发生PE分娩的个体特异性风险，将母亲特征和病史带来的既往风险与MAP、UtA-PI、PlGF和sFlt-1的MoM值相结合。基于这些风险，将人群分为高、中、低风险组。采用不同的风险临界值来改变分层到各风险类别的人群比例，并评估评估后<4周发生PE分娩及评估后4周直至40周妊娠发生PE分娩的筛查效果。
8128例单胎妊娠的研究人群中，有234例（2.9%）随后发生了PE。对于评估后<4周发生PE的情况，采用1/50的风险临界值；对于<40周妊娠发生PE的情况，采用1/150的风险临界值，分层到高、中、低风险的人群比例分别约为3%、26%和71%。高风险组包含评估后<4周发生PE的妊娠的90%以及评估后4周直至40周妊娠发生PE的妊娠的40%。中风险组包含评估后4周直至40周妊娠发生PE的女性中的另外49%。在低风险组中，没有女性在评估后<4周发生PE，只有0.3%的女性在评估后4周直至40周妊娠发生PE。
本研究提出了孕30 - 34周联合检测对PE进行风险分层的方法，旨在识别出从初次评估时起直至40周妊娠需要强化监测的高风险组，以及从初次评估后4周起直至40周妊娠需要监测的中风险组。所有妊娠在40周妊娠时都需要重新评估。版权所有© 2016 ISUOG。由John Wiley & Sons Ltd.出版
