Adjahou S, Logdanidis V, Wright A, Syngelaki A, Akolekar R, Nicolaides K H
Fetal Medicine Research Institute, King's College Hospital, London, UK.
Institute of Health Research, University of Exeter, Exeter, UK.
Ultrasound Obstet Gynecol. 2025 Jun;65(6):694-702. doi: 10.1002/uog.29222. Epub 2025 Apr 18.
To stratify pregnancy care based on the estimated risk of pre-eclampsia (PE) from screening at 19-24 weeks' gestation by combinations of maternal risk factors, estimated fetal weight (EFW), mean arterial pressure (MAP) and uterine artery pulsatility index (UtA-PI).
The data for this study were derived from a prospective non-interventional study in 134 443 women with a singleton pregnancy attending for a routine ultrasound scan at 19 + 0 to 23 + 6 weeks' gestation in two UK maternity hospitals. The visit included recording of maternal demographic characteristics and medical history, sonographic EFW and measurement of MAP and UtA-PI. The competing-risks model was used to estimate the individual patient-specific risk of delivery with PE at < 28, < 32 and < 36 weeks' gestation. Receiver-operating-characteristics curves were constructed for screen-positive rates (SPRs) at different detection rates of delivery with PE at < 28, < 32 and < 36 weeks' gestation for the combinations of maternal risk factors, EFW and MAP, and of maternal risk factors, EFW, MAP and UtA-PI. Different risk cut-offs were used with the intention of detecting about 80%, 85% and 90% of cases of delivery with PE at < 28, < 32 and < 36 weeks' gestation. Calibration for risk of delivery with PE at < 28, < 32 and < 36 weeks' gestation was assessed by plotting the observed incidence of PE against the predicted incidence of PE.
The study population contained 4335 (3.2%) women that subsequently developed PE, including 64 (0.05%) that delivered with PE at < 28 weeks' gestation, 209 (0.2%) that delivered with PE at < 32 weeks and 655 (0.5%) that delivered with PE at < 36 weeks. If the objective of screening was to identify about 90% of cases of delivery with PE at < 28, < 32 and < 36 weeks and the method of screening was a combination of maternal risk factors, EFW and MAP, the respective SPRs would be 11.0%, 18.3% and 38.8%. If the method of screening also included UtA-PI, the respective SPRs would be 2.6%, 3.8% and 23.6%. If the objective of screening was to identify about 80% of cases of delivery with PE at < 28, < 32 and < 36 weeks and the method of screening was a combination of maternal risk factors, EFW and MAP, the respective SPRs would be 5.9%, 9.7% and 21.9%. If the method of screening also included UtA-PI, the respective SPRs would be 1.0%, 2.1% and 11.7%. The calibration plots demonstrated good agreement between the estimated risk and observed incidence of PE.
All women should be offered assessment of risk for PE at 11-13 weeks, to help identify those requiring aspirin prophylaxis to reduce the rate of preterm PE, and at 35-37 weeks, to determine the optimal timing of birth to reduce the rate of term PE. Assessment of risk for PE at mid-gestation can be used to identify the subgroups that require additional monitoring at 24-35, 28-35 and 32-35 weeks' gestation. The best performance of screening, reflected in the SPR necessary to achieve a high detection rate, is achieved by a combination of maternal risk factors, MAP and UtA-PI. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
根据孕19 - 24周筛查时子痫前期（PE）的估计风险，通过母体风险因素、估计胎儿体重（EFW）、平均动脉压（MAP）和子宫动脉搏动指数（UtA - PI）的组合对孕期护理进行分层。
本研究数据来自一项前瞻性非干预性研究，研究对象为英国两家妇产医院134443名单胎妊娠女性，她们在孕19⁺⁰至23⁺⁶周进行常规超声扫描。此次就诊包括记录母体人口统计学特征和病史、超声测量EFW以及测量MAP和UtA - PI。采用竞争风险模型估计个体患者在孕<28周、<32周和<36周时发生PE分娩的特定风险。针对母体风险因素、EFW和MAP的组合，以及母体风险因素、EFW、MAP和UtA - PI的组合，构建不同孕周（<28周、<32周和<36周）PE分娩不同检出率下的筛查阳性率（SPR）的受试者操作特征曲线。使用不同的风险截断值，旨在检测孕<28周、<32周和<36周时约80%、85%和90%的PE分娩病例。通过绘制观察到的PE发病率与预测的PE发病率，评估孕<28周、<32周和<36周时PE分娩风险的校准情况。
研究人群中有4335名（3.2%）女性随后发生PE，其中64名（0.05%）在孕<28周时发生PE分娩，209名（0.2%）在孕<32周时发生PE分娩，655名（0.5%）在孕<36周时发生PE分娩。如果筛查目标是识别孕<28周、<32周和<36周时约90%的PE分娩病例，且筛查方法是母体风险因素、EFW和MAP的组合，相应的SPR分别为11.0%、18.3%和38.8%。如果筛查方法还包括UtA - PI，相应的SPR分别为。如果筛查目标是识别孕<28周、<32周和<36周时约80%的PE分娩病例，且筛查方法是母体风险因素、EFW和MAP的组合，相应的SPR分别为5.9%、9.7%和21.9%。如果筛查方法还包括UtA - PI，相应的SPR分别为1.0%、2.1%和11.7%。校准图显示PE估计风险与观察到的发病率之间具有良好的一致性。
所有女性均应在孕11 - 13周接受PE风险评估，以帮助识别需要阿司匹林预防以降低早产PE发生率的女性，并在孕35 - 37周进行评估，以确定最佳分娩时机以降低足月PE发生率。孕中期的PE风险评估可用于识别在孕24 - 35周、28 - 35周和32 - 35周需要额外监测的亚组。通过母体风险因素、MAP和UtA - PI的组合可实现最佳筛查效果，这体现在实现高检出率所需的SPR上。© 2025作者。由John Wiley & Sons Ltd代表国际妇产科超声学会出版的《妇产科超声》。
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