Novillo-Del Álamo Blanca, Martínez-Varea Alicia, Sánchez-Arco Carmen, Simarro-Suárez Elisa, González-Blanco Iker, Nieto-Tous Mar, Morales-Roselló José
Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026 Valencia, Spain.
Department of Medicine, CEU Cardenal Herrera University, 12006 Castellón de la Plana, Spain.
J Pers Med. 2024 Oct 13;14(10):1059. doi: 10.3390/jpm14101059.
BACKGROUND/OBJECTIVES: Preeclampsia (PE) is a systemic disease that affects 4.6% of pregnancies. Despite the existence of a first-trimester screening for the prediction of preterm PE, no consensus exists regarding neither the right moment to end the pregnancy nor the appropriate variables to estimate the prognosis. The objective of this study was to obtain a prediction model for perinatal death in patients with preterm PE, useful for clinical practice.
Singleton pregnant women with PE and preterm delivery were included in an observational retrospective study. Multiple maternal and fetal variables were collected, and several multivariable logistic regression analyses were applied to construct models to predict perinatal death, selecting the most accurate and reproducible according to the highest area under the curve (AUC) and the lowest Akaike Information Criteria (AIC).
A group of 148 pregnant women were included, and 18 perinatal deaths were registered. Univariable logistic regression selected as statistically significant variables the following: gestational age (GA) at admission, fetal sex, poor response to antihypertensive drugs, PlGF, umbilical artery (UA) pulsatility index (PI), cerebroplacental ratio (CPR), and absent/reversed ductus venosus (DV). The multivariable model, including all these parameters, presented an AUC of 0.95 and an AIC of 76.5. However, a model including only GA and fetal sex presented a similar accuracy with the highest simplicity (AUC 0.93, AIC 67.6). Finally, in fetuses with a similar GA, fetal death became dependent on PlGF and fetal sex, underlying the role of fetal sex in all circumstances.
Female fetal sex and low PlGF are notorious predictors of perinatal death in preterm PE, only surpassed by early GA at birth.
背景/目的：子痫前期（PE）是一种影响4.6%妊娠的全身性疾病。尽管存在用于预测早产PE的孕早期筛查，但对于终止妊娠的合适时机以及评估预后的适当变量尚无共识。本研究的目的是获得一个用于早产PE患者围产期死亡的预测模型，以用于临床实践。
将患有PE且早产的单胎孕妇纳入一项观察性回顾性研究。收集了多个母体和胎儿变量，并应用多种多变量逻辑回归分析来构建预测围产期死亡的模型，根据曲线下面积（AUC）最高和赤池信息准则（AIC）最低选择最准确和可重复的模型。
纳入了148名孕妇，记录到18例围产期死亡。单变量逻辑回归选择以下具有统计学意义的变量：入院时的孕周（GA）、胎儿性别、对抗高血压药物反应不佳、胎盘生长因子（PlGF）、脐动脉（UA）搏动指数（PI）、脑胎盘比值（CPR）以及静脉导管（DV）缺失/反向。包含所有这些参数的多变量模型的AUC为0.95，AIC为76.5。然而，仅包含GA和胎儿性别的模型具有相似的准确性且最为简单（AUC 0.93，AIC 67.6）。最后，在孕周相似的胎儿中，胎儿死亡取决于PlGF和胎儿性别，这凸显了胎儿性别在所有情况下的作用。
女性胎儿性别和低PlGF是早产PE围产期死亡的显著预测因素，但仅被出生时较早的孕周所超越。
