Publication:

An observational study on use of maternal risk factors, mean arterial pressure, mean uterine artery pulsatility index and serum placenta like growth factor for screening of preeclampsia in first trimester

Background Preeclampsia (PE) affects 2-3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. In the last decade extensive research has been devoted to screening for PE with the aim of reducing the prevalence of the disease through pharmacological intervention in the high-risk group. In our study we used the combined screening method to evaluate the risk of developing preeclampsia in pregnant women. Our primary objective was to estimate the screen positivity rate for preeclampsia using the first trimester combined screening method (maternal risk factors and biophysical methods) in our population in a tertiary care hospital setting.

Methods Risk of preeclampsia was calculated using fetal medicine foundation algorithm accessed at https://fetalmedicine.org/research/assess/preeclampsia.

Results Using the combined screening method, 10 out of 75 women (13.33%) were found to be screen positive for risk of developing preterm preeclampsia (at <37 weeks) with a risk cut off of 1:100. Using the maternal risk factors approach only (as per NICE guidelines) again 10 out of 75 women (13.3%) were found to be screen positive. However, the subset of women who were screen positive by each method were not the same. There were only 4 out of 10 women who were screen positive by both methods. The screen positivity rate for preterm preeclampsia (<37 weeks) in our population using combined screening approach was 13%, which means aspirin would be advisable to 13/100 pregnant women to reduce the risk of preterm preeclampsia.

Conclusions Basis on our study we concluded that one cost effective method of screening could be, to offer aspirin to all women who are screen positive by the maternal risk factor approach (NICE guidelines approach). This approach does not require any extra blood test or skill to measure uterine artery pulsatility index.