NIHR BRC Reproductive and Perinatal Health Group, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
Tommy's Maternal and Fetal Research Centre, Manchester Academic Health Science Centre, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, 5th Floor (Research), St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
Syst Rev. 2020 Apr 8;9(1):78. doi: 10.1186/s13643-020-01334-5.
Pre-eclampsia and being born small for gestational age are associated with significant maternal and neonatal morbidity and mortality. Placental dysfunction is a key pathological process underpinning these conditions; thus, markers of placental function have the potential to identify pregnancies ending in pre-eclampsia, fetal growth restriction, and the birth of a small for gestational age infant.
To assess the predictive ability of late pregnancy (after 24 weeks' gestation) tests in isolation or in combination for adverse pregnancy outcomes associated with placental dysfunction, including pre-eclampsia, fetal growth restriction, delivery of a SGA infant (more specifically neonatal growth restriction), and stillbirth.
Studies assessing the ability of biochemical tests of placental function and/or ultrasound parameters in pregnant women beyond 24 weeks' gestation to predict outcomes including pre-eclampsia, stillbirth, delivery of a SGA infant (including neonatal growth restriction), and/or fetal growth restriction will be identified by searching the following databases: EMBASE, MEDLINE, Cochrane CENTRAL, Web of Science, CINAHL, ISRCTN registry, UK Clinical Trials Gateway, and WHO International Clinical Trials Portal. Any study design in which the biomarker and ultrasound scan potential predictors have been assessed after 24 weeks' gestation but before diagnosis of outcomes (pre-eclampsia, fetal growth restriction, SGA (including neonatal growth restriction), and stillbirth) will be eligible (this would include randomized control trials and nested prospective case-control and cohort studies), and there will be no restriction on the background risk of the population. All eligible studies will be assessed for risk of bias using the modified QUADAS-2 tool. Meta-analyses will be undertaken using the ROC models to estimate and compare test discrimination and reclassification indices to test calibration. Validation will be explored by comparing consistency across studies.
This review will assess whether current published data reporting either a single or combination of tests in late pregnancy can accurately predict adverse pregnancy outcome(s) associated with placental dysfunction. Accurate prediction could allow targeted management and possible intervention for high-risk pregnancies, ultimately avoiding adverse outcomes associated with placental disease.
PROSPERO CRD42018107049.
子痫前期和胎儿生长受限与母婴发病率和死亡率显著相关。胎盘功能障碍是这些疾病的关键病理过程；因此，胎盘功能标志物有可能识别出最终导致子痫前期、胎儿生长受限和出生体重小于胎龄儿的妊娠。
评估单独或联合使用妊娠晚期（24 周后）检测对与胎盘功能障碍相关的不良妊娠结局（包括子痫前期、胎儿生长受限、出生体重小于胎龄儿（包括新生儿生长受限）和死胎）的预测能力。
通过搜索以下数据库，确定评估妊娠 24 周后生化胎盘功能检测和/或超声参数对包括子痫前期、死胎、出生体重小于胎龄儿（包括新生儿生长受限）和/或胎儿生长受限在内的结局预测能力的研究：EMBASE、MEDLINE、Cochrane 中心、Web of Science、CINAHL、ISRCTN 注册处、英国临床试验网关和世卫组织国际临床试验门户。任何研究设计，只要在诊断结局（子痫前期、胎儿生长受限、SGA（包括新生儿生长受限）和死胎）之前，在 24 周后评估生物标志物和超声扫描的潜在预测因素，都将符合条件（包括随机对照试验和嵌套前瞻性病例对照和队列研究），且人群的背景风险不受限制。所有符合条件的研究都将使用修改后的 QUADAS-2 工具评估偏倚风险。将使用 ROC 模型进行荟萃分析，以估计和比较测试的判别和重新分类指数，以测试校准。通过比较研究之间的一致性来探索验证。
本综述将评估目前报告妊娠晚期单一或联合检测的已发表数据是否能够准确预测与胎盘功能障碍相关的不良妊娠结局。准确的预测可以为高危妊娠提供靶向管理和可能的干预措施，最终避免与胎盘疾病相关的不良结局。
PROSPERO CRD42018107049。
