Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Institute of Health Research, University of Exeter, Exeter, UK.
Ultrasound Obstet Gynecol. 2018 Oct;52(4):501-506. doi: 10.1002/uog.19111. Epub 2018 Aug 27.
To examine the performance of screening for pre-eclampsia (PE) at 35-37 weeks' gestation by maternal factors and combinations 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).
This was a prospective observational study in women with singleton pregnancy attending for an ultrasound scan at 35 + 0 to 36 + 6 weeks as part of routine pregnancy care. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics and medical history, with various combinations of biomarker multiples of the median (MoM) values to derive the patient-specific risks of delivery with PE. The performance of such screening was estimated.
The study population of 13 350 pregnancies included 272 (2.0%) that subsequently developed PE. In pregnancies that developed PE, the MoM values of MAP, UtA-PI and sFlt-1 were increased and PlGF MoM was decreased. At a risk cut-off of 1 in 20, the proportion of the population stratified into high risk was about 10% of the total, and the proportion of cases of PE contained within this high-risk group was 28% with screening by maternal factors alone; the detection rate increased to 53% with the addition of MAP, 67% with the addition of MAP and PlGF and 70% with the addition of MAP, PlGF and sFlt-1. The performance of screening was not improved by the addition of UtA-PI. The performance of screening depended on the racial origin of the women; in screening by a combination of maternal factors, MAP, PlGF and sFlt-1 and use of the risk cut-off of 1 in 20, the detection rate and screen-positive rate were 66% and 9.5%, respectively, for Caucasian women and 88% and 18% for those of Afro-Caribbean racial origin.
Screening by maternal factors and biomarkers at 35-37 weeks' gestation can identify a high proportion of pregnancies that develop late PE. The performance of screening depends on the racial origin of the women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
通过母体因素和平均动脉压（MAP）、子宫动脉搏动指数（UtA-PI）、血清胎盘生长因子（PlGF）和血清可溶性 fms 样酪氨酸激酶-1（sFlt-1）的组合，来检验在 35-37 孕周筛查子痫前期（PE）的表现。
这是一项在单胎妊娠妇女中进行的前瞻性观察性研究，她们在 35+0 至 36+6 周期间进行超声检查，作为常规妊娠护理的一部分。贝叶斯定理用于将从母体特征和病史中获得的分娩时 PE 的先验分布与各种生物标志物中位数倍数（MoM）值的组合相结合，以得出具有 PE 的患者特定分娩风险。评估了这种筛查的性能。
在 13350 例妊娠中，有 272 例（2.0%）随后发生了 PE。在发生 PE 的妊娠中，MAP、UtA-PI 和 sFlt-1 的 MoM 值增加，PlGF MoM 值降低。在风险截止值为 1/20 的情况下，约有 10%的人群被划分为高危人群，而仅用母体因素进行筛查时，这一高危人群中包含的 PE 病例比例为 28%；随着 MAP 的加入，检出率增加到 53%，随着 MAP 和 PlGF 的加入，检出率增加到 67%，随着 MAP、PlGF 和 sFlt-1 的加入，检出率增加到 70%。UtA-PI 的加入并未改善筛查的性能。筛查的性能取决于妇女的种族起源；在用母体因素、MAP、PlGF 和 sFlt-1 的组合进行筛查，并使用 1/20 的风险截止值时，对于白种妇女，检出率和阳性检出率分别为 66%和 9.5%，对于非裔加勒比种族的妇女，检出率和阳性检出率分别为 88%和 18%。
在 35-37 孕周时通过母体因素和生物标志物筛查，可以识别出很大比例的发生晚期 PE 的妊娠。筛查的性能取决于妇女的种族起源。版权所有©2018ISUOG。由 John Wiley & Sons Ltd 出版。
