Concordance-analysis and evaluation of different diagnostic algorithms used in first trimester screening for late-onset preeclampsia

Identifying Predictor Variables for a Composite Risk Prediction Tool for Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Modified Delphi Study

A composite cardiometabolic risk prediction tool will support the systematic identification of women at increased cardiometabolic risk during pregnancy to enable early screening and intervention. This study aims to identify and select predictor variables for a composite risk prediction tool for cardiometabolic risk (gestational diabetes mellitus and/or hypertensive disorders of pregnancy) for use in the first trimester. A two-round modified online Delphi study was undertaken. A prior systematic literature review generated fifteen potential predictor variables for inclusion in the tool. Multidisciplinary experts (n = 31) rated the clinical importance of variables in an online survey and nominated additional variables for consideration (Round One). An online meeting (n = 14) was held to deliberate the importance, feasibility and acceptability of collecting variables in early pregnancy. Consensus was reached in a second online survey (Round Two). Overall, 24 variables were considered; 9 were eliminated, and 15 were selected for inclusion in the tool. The final 15 predictor variables related to maternal demographics (age, ethnicity/race), pre-pregnancy history (body mass index, height, history of chronic kidney disease/polycystic ovarian syndrome, family history of diabetes, pre-existing diabetes/hypertension), obstetric history (parity, history of macrosomia/pre-eclampsia/gestational diabetes mellitus), biochemical measures (blood glucose levels), hemodynamic measures (systolic blood pressure). Variables will inform the development of a cardiometabolic risk prediction tool in subsequent research. Evidence-based, clinically relevant and routinely collected variables were selected for a composite cardiometabolic risk prediction tool for early pregnancy.

Role of Maternal Uterine Artery Doppler Versus Serum β-hCG During the First Trimester in the Prediction of Preeclampsia and IUGR

Objective:

Preeclampsia accounts for 15% of maternal deaths and may cause fetal morbidity and mortality. The aim of this research was to evaluate the efficacy of maternal uterine artery Doppler versus serum beta-human chorionic gonadotropin (β-hCG), during the first trimester, in predicting preeclampsia and intrauterine growth restriction (IUGR).

Materials and Methods:

In a convenient sample of 388 pregnant women, uterine artery resistive index (RI) and pulsatility index (PI) were assessed, and serum β-hCG level was measured at 11 to 13 weeks of gestation. The patients’ maternal blood pressure and fetal growth were monitored.

Results:

The patients with preeclampsia (n = 58) showed a significant uterine RI and PI increase with a significant β-hCG decrease compared with the normotensive patients (n = 330). The specificity of uterine PI and RI to predict preeclampsia and IUGR is higher than that of β-hCG. However, the sensitivity of combined diagnostic tools is higher than the singular use of these diagnostic tests.

Conclusion:

Uterine artery Doppler may be better than serum β-hCG in predicting preeclampsia and IUGR. However, combined diagnostic techniques may be better to screen at-risk patients.