Rolnik Daniel L, Selvaratnam Roshan J, Wertaschnigg Dagmar, Meagher Simon, Wallace Euan, Hyett Jon, da Silva Costa Fabricio, McLennan Andrew
Department of Obstetrics and Gynaecology, The Ritchie Centre, Monash University, Clayton, Victoria, Australia.
Department of Health and Human Services, Safer Care Victoria, Victorian Government, Victoria, Australia.
Int J Gynaecol Obstet. 2022 Sep;158(3):634-642. doi: 10.1002/ijgo.14049. Epub 2021 Dec 11.
To assess pregnancy outcomes following first trimester combined screening for preterm preeclampsia in Australia.
We compared pregnancy outcomes of women with singleton pregnancies who underwent first trimester combined preeclampsia screening with the Fetal Medicine Foundation algorithm between 2014 and 2017 in Melbourne and Sydney, Australia, with those from women who received standard care. The primary outcomes were preterm preeclampsia and screening performance. Effect estimates were presented as risk ratios with 95% confidence intervals.
A total of 29 618 women underwent combined screening and 301 566 women received standard care. Women who had combined screening were less likely to have preeclampsia, preterm birth, small neonates, and low Apgar scores than the general population. Women with high-risk results (≥1 in 100) were more likely to develop preterm preeclampsia (2.1% vs. 0.7%, risk ratio [RR] 3.04, 95% CI 2.46-3.77), while low-risk women (risk <1 in 100) had lower rates of preterm preeclampsia (0.2% vs. 0.7%, RR 0.26, 95% CI 0.19-0.35) and other pregnancy complications. Screening detected 65.2% (95% CI 56.4-73.2%) of all preterm preeclampsia cases, with improved performance after adjustment for treatment effect.
First trimester screening for preeclampsia in clinical practice identified a population at high risk of adverse pregnancy outcomes and low-risk women who may be suitable for less intensive antenatal care.
评估澳大利亚孕早期联合筛查早产子痫前期后的妊娠结局。
我们比较了2014年至2017年在澳大利亚墨尔本和悉尼接受孕早期子痫前期联合筛查（采用胎儿医学基金会算法）的单胎妊娠女性与接受标准护理的女性的妊娠结局。主要结局为早产子痫前期和筛查性能。效应估计值以风险比及95%置信区间表示。
共有29618名女性接受了联合筛查，301566名女性接受了标准护理。接受联合筛查的女性患子痫前期、早产、新生儿体重低和阿氏评分低的可能性低于普通人群。高危结果（≥1/100）的女性发生早产子痫前期的可能性更高（2.1%对0.7%，风险比[RR]3.04，95%CI 2.46 - 3.77），而低危女性（风险<1/100）发生早产子痫前期的几率较低（0.2%对0.7%，RR 0.26，95%CI 0.19 - 0.35）以及其他妊娠并发症。筛查发现了所有早产子痫前期病例的65.2%（95%CI 56.4 - 73.2%），在调整治疗效果后性能有所改善。
临床实践中孕早期子痫前期筛查识别出了不良妊娠结局高危人群以及可能适合接受强度较低产前护理的低危女性。
