First trimester screening of late-onset preeclampsia in a low risk and low volume obstetrical setting: external validation of a predictive model
DOI:
https://doi.org/10.23938/ASSN.0279Keywords:
Preeclampsia. External validation. Predictive model. Low risk patients. Low obstetric setting.Abstract
Background. The external validation of predictive model of late preeclampsia in a low volume and low risk obstetrical setting.
Methods. A cohort was created of 174 singleton pregnancies of 11+0-13+6 gestational weeks at Clinica Universidad Navarra from September 2011 to March 2013, which was considered as a validation cohort of a previously described model for late PE (Hospital Clinic, Barcelona).
Results. A total of 7 (4%) women developed late PE. In the validation cohort the area under the curve of the model was 0.69 (95% CI 0.45-0.93). Detection rates for a 5, 10 and 15% of false positive rates were 21.9, 31.4% and 38.6% respectively. When comparing the areas under the curve of the validation cohort with the construction cohort, no statistical differences were found (p=0.68).
Conclusion. The combination of maternal history, pregnancy associated plasma protein-A and mean arterial pressure is moderately useful to predict preeclampsia in a low risk and low volume obstetrical setting. The predictive model of the Clinic Hospital of Barcelona is a valid tool in predicting late preeclampsia in this setting.
Downloads
References
1. POON L, AKOLEKAR R, LACHMANN R, BETA J AND NICOLAIDES K. Hypertensive disorders in pregnancy: screening by biophysical and biochemical markers at 11-13 weeks. Ultrasound Obstet Gynecol 2010; 35: 662-670.
https://doi.org/10.1002/uog.7628
2. JAMES J, WHITLEY G. Pre-eclampsia: fitting together the placental, immune and cardiovascular pieces. J Pathol 2010; 221: 363-378.
https://doi.org/10.1002/path.2719
3. CERDEIRA A, KARUMANCHI A. Biomarkers in preeclampsia. Biomarkers in kidney disease 2010; 11: 385-426.
https://doi.org/10.1016/B978-0-12-375672-5.10011-8
4. POPRAWSKI G, WENDER-OZEGOWSKA E, ZAWIEJSKA A, BRAZERT J . Modern methods of early screening for preeclampsia and pregnancy induced hypertension a review. Ginekol Pol 2012; 83: 688-693.
5. POON L, KAMETAS N, MAIZ N, AKOLEKAR R, NICOLAIDES K. First-trimester prediction of hypertensive disorders in pregnancy. Hypertension 2009; 53: 812-818.
https://doi.org/10.1161/HYPERTENSIONAHA.108.127977
6. POON LC, KAMETAS NA, VALENCIA C, CHELEMEN T, NICOLAIDES KH. Hypertensive disorders in pregnancy: screening by systolic diastolic and mean arterial pressure at 11-13 weeks. Hypertens Pregnancy 2011; 30: 93-107.
https://doi.org/10.3109/10641955.2010.484086
7. CUCKLE HS. Screening for Pre-eclampsia-lessons from aneuploidy screening. Placenta 2011; 32: 42-48.
https://doi.org/10.1016/j.placenta.2010.07.015
8. POON L, KAMETAS NA, CHELEMEN T, LEAL A, NICOLAIDES KH. Maternal risk factors for hypertensive disorders in pregnancy: a multivariate approach risk for hypertensive disorders. J Human Hypertension 2010; 24: 104-110.
https://doi.org/10.1038/jhh.2009.45
9. POON LCY, STABOULIDOU I, MAIZ N, PLASENCIA W, NICOLAIDES KH. Hypertensive disorders in pregnancy: screening by uterine artery doppler at 11-13 weeks. Ultrasound Obstet Gynecol 2009; 34: 142-148.
https://doi.org/10.1002/uog.6452
10. POON LC, KARAGIANNIS G, LEAL A, ROMERO XC, NICOLAIDES KH. Hypertensive disorders in pregnancy: screening by uterine artery doppler imaging and blood pressure at 11-13 weeks. Ultrasound Obstet Gynecol 2009; 34: 497-502.
https://doi.org/10.1002/uog.7439
11. SCAZZOCCHIO E, FIGUERAS F, CRISPI F, MELER E, MASOLLER N, MULA R et al. Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting. Am J Obstet Gynecol 2013; 208: 203.e1-203.e10.
https://doi.org/10.1016/j.ajog.2012.12.016
12. ROBINSON HP, FLEMING J. A critical evaluation of sonar "crown-rump length" measurements. BJOG: An International Journal of Obstetrics & Gynaecology 1975; 82: 702-710.
https://doi.org/10.1111/j.1471-0528.1975.tb00710.x
13. HOLLIS B, MAVRIDES E, CAMPBELL S, TEKAY A, THILAGANATHA B. Reproducibility and repeatability of transabdominal uterine artery doppler velocimetry between 10 and 14 weeks of gestation. Ultrasound obstetrics gynecology 2001; 18: 593-597.
https://doi.org/10.1046/j.0960-7692.2001.00544.x
14. HANLEY J. The robustness of the binormal assumptions used in fitting ROC curves. Med Decis Making 1988; 8: 197-203.
https://doi.org/10.1177/0272989X8800800308
15. DELONG E, DELONG DM, CLARKE-PEARSON D. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44: 837-845.
https://doi.org/10.2307/2531595
16. SIBAI BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002; 100: 369-377.
https://doi.org/10.1097/00006250-200212000-00037
17. BARTON J, SIBAI B. Prediction and prevention of recurrent preeclampsia. Fetal Diagn Ther 2008; 112: 359-372.
https://doi.org/10.1097/AOG.0b013e3181801d56
18. CATOV J, NESS R. Risk of early or severe preeclampsia related to preexisting condition. Int J Epidemiol 2007; 36: 412-419.
https://doi.org/10.1093/ije/dyl271
19. FRISHMAN W, SCHLOCKER S. Pathophysiology and medical management of systemic hypertension in pregnancy. Cardiology Rev 2005; 13: 274-284.
https://doi.org/10.1097/01.crd.0000137738.16166.cc
20. PRADO D, PIOVESAN D. Association of anticardiolipin antibodies with preeclampsia: a systematic review and meta-analysis. Obstet Gynecol 2010; 116: 1433-1443.
https://doi.org/10.1097/AOG.0b013e3181fe02ec
21. BRANCH W, FLINT DT. Antiphospholipid antibodies in women at risk for preeclampsia. Am J Obstet Gynaecol 2001; 184: 825-834.
https://doi.org/10.1067/mob.2001.113846
22. HERNÁNDEZ-DIAZ S, TOH S. Risk of preeclampsia in first and subsequent pregnancies: prospective cohort study. BMJ 2009; 338: b2225.
https://doi.org/10.1136/bmj.b2255
23. HAWFIELD A, FREEDMAN B. Pre-eclampsia:the pivotal role of the placenta in its pathophysiology and markers of early detection. Ther Adv Cardiovasc Dis 2009; 3: 65-73.
https://doi.org/10.1177/1753944708097114
24. LIN J, AUGUST P. Genetic thrombophilias and preclampsia: a meta-analysis. Amer College Obstet Gynaecol 2005; 105: 182-192.
https://doi.org/10.1097/01.AOG.0000146250.85561.e9
25. ALTMAN DG, VERGOUWE Y, ROYSTON P, MOONS KG. Prognosis and prognostic research: validating a prognostic model. BMJ 2009; 338: 1432-1435.
https://doi.org/10.1136/bmj.b605
26. AKOLEKAR R, SYNGELAKI A, POON L, WRIGHT D, NICOLAIDES KH. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn Ther 2013; 33: 8-15.
https://doi.org/10.1159/000341264
27. PARK F, LEUNG C, POON LCY, WILLIAMS P, ROTHWELL S, HYETT J. Clinical evaluation of a first trimester algorithm predicting the risk of hypertensive disease of pregnancy. Australian New Zealand J Obstet Gynaecol 2013; 53: 532-539.
https://doi.org/10.1111/ajo.12126
28. CRISPI F, DOMINGUEZ C, LLURBA E, MARTIN-GALLAN P, GRATACOS E. Placental angiogenic growth factors and uterine artery doppler findings for characterization of different subsets in preeclampsia and in isolated intrauterine growth restriction. Am J Obstet Gynecol 2006; 195: 201-207.
https://doi.org/10.1016/j.ajog.2006.01.014
29. KOOPMANS CM, BIJLENGA D, GROEN H, VIJGEN SM, AARNOUDSE JG, BEKEDAM DJ et al. HYPITAT study group. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet 2009; 374: 979-988.
https://doi.org/10.1016/S0140-6736(09)60736-4
30. CROVETTO F, FIGUERAS F, TRIUNFO S, CRISPI F, RODRIGUEZ-SUREDA V, PEGUERO A et al. Added value of angiogenic factors for the prediction of early and late preeclampsia in the first trimester of pregnancy. Fetal Diagn Ther 2014; 35: 258-266.
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
