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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(12): 1354-1361
DOI: 10.1055/a-1332-1437
GebFra Science
Original Article

Reducing the Risk of Preterm Preeclampsia: Comparison of Two First Trimester Screening and Treatment Strategies in a Single Centre in Switzerland

Minderung des Risikos für Präeklampsie vor 37 Schwangerschaftswochen: Vergleich zweier Ersttrimesterscreening- und Behandlungsstrategien in einem Zentrum in der Schweiz
Sofia Amylidi-Mohr
1   Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
,
Jakub Kubias
1   Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
,
Stefanie Neumann
1   Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
,
Daniel Surbek
1   Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
,
Lorenz Risch
2   Division of Clinical Chemistry, Labormedizinisches Zentrum Dr. Risch, Bern, Switzerland
,
Luigi Raio
1   Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
,
Beatrice Mosimann
1   Department of Obstetrics and Gynaecology, University Hospital of Bern, University of Bern, Inselspital, Bern, Switzerland
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Abstract

Introduction First trimester screening for preeclampsia (PE) is based on the combined risks model. Recent trials demonstrate that variations in multiple of the medians (MoMs) of the screening markers influence the performance of the algorithm in different populations. The aim of this study is to compare the performance of the algorithm in two cohorts with different prevention strategies.

Material and Methods All first trimester screening tests performed between January 2014 and April 2020 were included. Up to June 2017 pregnancies with a risk > 1 : 200 for early-onset PE (eoPE) were considered at risk and received 100 mg of aspirin (strategy A). From July 2017 onwards, pregnancies with a risk > 1 : 100 for preterm PE (pPE) received 150 mg of aspirin (strategy B). We compared the screen positive rates (SPR) and incidence of PE between the two screening approaches. Statistical analysis were performed with Graphpad 8.0.

Results 3552 pregnancies were included; 1577 pregnancies were screened according to strategy A, 1975 pregnancies according to strategy B. The screen positive rate (SPR) for strategy A and B was 8.9 and 16.9% respectively (p < 0.0001) while the incidence of PE was 1.41 and 1.84% respectively (p = ns).

Conclusion With a SPR of less than 10% we achieved a remarkably low rate of PE in our population, no further reduction in PE could be achieved by an increase in the SPR and LDA-prescription during the second screening period. The cut-off to define a pregnancy at risk for PE should be tailored to keep the SPR below 10% to avoid unnecessary treatment with aspirin.

Zusammenfassung

Einleitung Das Ersttrimesterscreening auf Präeklampsie (PE) basiert auf einem Modell, das Risiken kombiniert. Vor Kurzem durchgeführte Studien haben gezeigt, dass Variationen der MoM-Werte („multiple of the median“) der Screening-Marker die Leistung des Algorithmus in unterschiedlichen Populationen beeinflussen. Ziel dieser Studie war es, die Leistung des Algorithmus in 2 Kohorten mit unterschiedlichen Präventionsstrategien zu vergleichen.

Material und Methoden Es wurden alle Ersttrimesterscreening-Tests, die zwischen Januar 2014 und April 2020 durchgeführt wurden, in die Studie eingeschlossen. Bis zum Juni 2017 wurden Schwangerschaften mit einem Risiko von > 1 : 200 für eine früh auftretende PE (vor 34 SSW, eoPE) als Risikoschwangerschaft eingestuft und mit 100 mg Aspirin behandelt (Strategie A). Nach Juli 2017 wurden Schwangerschaften mit einem Risiko von > 1 : 100 für eine PE vor 37 SSW (pPE) mit 150 mg Aspirin behandelt (Strategie B). Wir verglichen die Screen-Positiv-Raten (SPR) und die Häufigkeit von PE der beiden Früherkennungsstrategien miteinander. Die statistische Analyse wurde mit Graphpad 8.0 durchgeführt.

Ergebnisse Insgesamt wurden 3552 Schwangerschaften in die Studie aufgenommen; davon wurden 1577 Schwangerschaften gemäß Strategie A und 1975 Schwangerschaften gemäß Strategie B untersucht und behandelt. Die Screening-Positiv-Rate (SPR) für Strategie A bzw. B war 8,9 bzw. 16,9% (p < 0,0001), und die Häufigkeit von PE war 1,41 bzw. 1,84% (p = n. s.).

Schlussfolgerung Mit einer SPR von weniger als 10 % konnten wir eine bemerkenswert niedrige PE-Rate bei unseren Patientinnen erzielen. Die PE-Rate wurde nicht weiter gesenkt durch die Erhöhung der SPR und der Aspirindosis im 2. Überwachungszeitraum. Der Schwellenwert für die Klassifizierung einer Schwangerschaft als PE-gefährdet sollte entsprechend so gewählt werden, dass die SPR unter 10 % bleibt, um eine unnötige Behandlung mit Aspirin zu vermeiden.

Key words

preeclampsia - first trimester screening - implementation

Schlüsselwörter

Präeklampsie - Ersttrimesterscreening - Durchführung


Publication History

Received: 10 November 2020

Accepted after revision: 07 December 2020

Article published online:
15 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009; 33: 130-137
    CrossrefPubMedGoogle Scholar
  • 2 Abalos E, Cuesta C, Grosso AL. et al. Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 2013; 170: 1-7
    CrossrefPubMedGoogle Scholar
  • 3 Ghossein-Doha C, van Neer J, Wissink B. et al. Pre-eclampsia: an important risk factor for asymptomatic heart failure. Ultrasound Obstet Gynecol 2017; 49: 143-149
    CrossrefPubMedGoogle Scholar
  • 4 Sehgal A, Skilton MR, Crispi F. Human fetal growth restriction: a cardiovascular journey through to adolescence. J Dev Orig Health Dis 2016; 7: 626-635
    CrossrefPubMedGoogle Scholar
  • 5 Tan MY, Syngelaki A, Poon LC. et al. Screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeksʼ gestation. Ultrasound Obstet Gynecol 2018; 52: 186-195
    CrossrefPubMedGoogle Scholar
  • 6 Akolekar R, Syngelaki A, Poon L. et al. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn Ther 2013; 33: 8-15
    CrossrefPubMedGoogle Scholar
  • 7 Chaemsaithong P, Pooh RK, Zheng M. et al. Prospective evaluation of screening performance of first-trimester prediction models for preterm preeclampsia in an Asian population. Am J Obstet Gynecol 2019; 221: 650.e1-650.e16
    CrossrefPubMedGoogle Scholar
  • 8 Sonek J, Krantz D, Carmichael J. et al. First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volume. Am J Obstet Gynecol 2018; 218: 126.e1-126.e13
    CrossrefPubMedGoogle Scholar
  • 9 Chappell LC, Brocklehurst P, Green ME. et al. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 2019; 394: 1181-1190
    CrossrefPubMedGoogle Scholar
  • 10 Bujold E, Roberge S, Lacasse Y. et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116 (2 Pt 1): 402-414
    CrossrefPubMedGoogle Scholar
  • 11 Roberge S, Bujold E, Nicolaides KH. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol 2018; 218: 287-293.e1
    CrossrefPubMedGoogle Scholar
  • 12 Rolnik DL, Wright D, Poon LC. et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med 2017; 377: 613-622
    CrossrefPubMedGoogle Scholar
  • 13 Tan MY, Wright D, Syngelaki A. et al. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE. Ultrasound Obstet Gynecol 2018; 51: 743-750
    CrossrefPubMedGoogle Scholar
  • 14 Poon LC, Syngelaki A, Akolekar R. et al. Combined screening for preeclampsia and small for gestational age at 11–13 weeks. Fetal Diagn Ther 2013; 33: 16-27
    CrossrefPubMedGoogle Scholar
  • 15 OʼGorman N, Wright D, Poon LC. et al. Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeksʼ gestation. Ultrasound Obstet Gynecol 2017; 49: 751-755
    CrossrefPubMedGoogle Scholar
  • 16 Accessed May 06, 2021 at: http://fetalmedicine.org/education/preeclampsia-screening
  • 17 Mosimann B, Amylidi-Mohr S, Höland K. et al. Importance of Timing First-Trimester Placental Growth Factor and Use of Serial First-Trimester Placental Growth Factor Measurements in Screening for Preeclampsia. Fetal Diag Ther 2017; 42: 111-116
    CrossrefPubMedGoogle Scholar
  • 18 Tranquilli AL, Dekker G, Magee L. et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens 2014; 4: 97-104
    CrossrefPubMedGoogle Scholar
  • 19 Purde MT, Baumann M, Wiedemann U. et al. Incidence of preeclampsia in pregnant Swiss women. Swiss Med Wkly 2015; 145: w14175
    PubMedGoogle Scholar
  • 20 Chaemsaithong P, Sahota D, Pooh RK. et al. First-trimester pre-eclampsia biomarker profiles in Asian population: multicenter cohort study. Ultrasound Obstet Gynecol 2020; 56: 206-214
    CrossrefPubMedGoogle Scholar
  • 21 Akolekar R, Zaragoza E, Poon LC. et al. Maternal serum placental growth factor at 11 + 0 to 13 + 6 weeks of gestation in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2008; 32: 732-739
    CrossrefPubMedGoogle Scholar
  • 22 Poon LC, Kametas NA, Pandeva I. et al. Mean arterial pressure at 11(+ 0) to 13(+ 6) weeks in the prediction of preeclampsia. Hypertension 2008; 51: 1027-1033
    CrossrefPubMedGoogle Scholar
  • 23 Plasencia W, Maiz N, Poon L. et al. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks and 21 + 0 to 24 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet Gynecol 2008; 32: 138-146
    CrossrefPubMedGoogle Scholar
  • 24 Ridding G, Schluter PJ, Hyett JA. et al. Influence of sampling site on uterine artery Doppler indices at 11–13+6 weeks gestation. Fetal Diagn Ther 2015; 37: 310-315
    CrossrefPubMedGoogle Scholar
  • 25 Rolnik DL, da Silva Costa F, Sahota D. et al. Quality assessment of uterine artery Doppler measurement in first-trimester combined screening for pre-eclampsia. Ultrasound Obstet Gynecol 2019; 53: 245-250
    CrossrefPubMedGoogle Scholar
  • 26 Drouin O, Johnson JA, Chaemsaithong P. et al. Transverse technique: complementary approach to measurement of first-trimester uterine artery Doppler. Ultrasound Obstet Gynecol 2018; 52: 639-647
    CrossrefPubMedGoogle Scholar
  • 27 OʼGorman N, Wright D, Poon LC. et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeksʼ gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet Gynecol 2017; 49: 756-760
    CrossrefPubMedGoogle Scholar
  • 28 Guizani M, Valsamis J, Dutemeyer V. et al. First-Trimester Combined Multimarker Prospective Study for the Detection of Pregnancies at a High Risk of Developing Preeclampsia Using the Fetal Medicine Foundation-Algorithm. Fetal Diagn Ther 2018; 43: 266-273
    CrossrefPubMedGoogle Scholar
  • 29 Mosimann B, Pfiffner C, Amylidi-Mohr S. et al. First trimester combined screening for preeclampsia and small for gestational age – a single centre experience and validation of the FMF screening algorithm. Swiss Med Wkly 2017; 147: w14498
    PubMedGoogle Scholar
  • 30 Park FJ, Leung CH, Poon LC. et al. Clinical evaluation of a first trimester algorithm predicting the risk of hypertensive disease of pregnancy. Aust N Z J Obstet Gynaecol 2013; 53: 532-539
    CrossrefPubMedGoogle Scholar
  • 31 OʼGorman N, Wright D, Syngelaki A. et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11–13 weeks gestation. Am J Obstet Gynecol 2016; 214: 103.e1-103.e12
    CrossrefPubMedGoogle Scholar
  • 32 Xu TT, Zhou F, Deng CY. et al. Low-Dose Aspirin for Preventing Preeclampsia and Its Complications: A Meta-Analysis. J Clin Hypertens (Greenwich) 2015; 17: 567-573
    CrossrefPubMedGoogle Scholar