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First-trimester prediction of preeclampsia algorithm.
Source publication
Normal trophoblast growth is one of the more important stages of early pregnancy that has a deciding factor on its later development and normal outcome. Identifying pregnant women who have a high risk of complications connected to hypertension during pregnancy is currently one of the most important tasks of perinatal medicine. Abnormal placentation...
Context in source publication
Context 1
... biophys- ical and biochemical markers may improve detection of high risk patients, which may lead to the reduction of maternal morbidity and mortality. The best time to screen women for chromosomal disorders and pre- eclampsia is the first trimester of pregnancy (Figure 1). The practical application of the inverted pyramid of antenatal care, an idea proposed by Nicolaides, may determine valuable information on the future of the fetus and the pregnant mother during just one visit at the early stages of pregnancy (Nicolaides 2011). ...
Similar publications
To determine (1) whether maternal plasma concentrations of angiogenic and anti-angiogenic factors can predict which mothers diagnosed with "suspected small for gestational age fetuses (sSGA)" will develop pre-eclampsia (PE) or require an indicated early preterm delivery (≤ 34 weeks of gestation); and (2) whether risk assessment performance is impro...
Citations
... Nevertheless, PAPP-A concentrations do not seem to be an additional help in predicting SGA in ART with a better accuracy in comparison to general population. As GH, PE and growth restriction have a possible common underlying cause of impaired placentation [35], we decided to combine the above pathologies and verify PAPP-A MoM of affected and non-affected ART gestations. Although the results did not reach significance, probably due to the number of studied subjects, the trend for lower PAPP-A MoM was visible in affected patients (0.72 vs. 1.08; ...
Objectives
The aim of this study was to determine if the levels of biochemical aneuploidy markers in
Methods
This was a prospective observational study performed in a group of 551 patients who underwent a combined first trimester prenatal screening (ultrasound scan and serum markers). All patients were divided into two groups according to the mode of conception: IVF/ICSI pregnancies (study group) and spontaneous conceptions (control group). The concentrations of first trimester biochemical markers were presented as multiples of median (MoM) and were compared between the study and control groups. Analysed pregnancy complications included: preterm delivery (PTD), small for gestational age (SGA), gestational hypertension (GH), preeclampsia (PE) and gestational diabetes (GDM).
Results
The analysis was performed on 183 IVF/ICSI and 368 spontaneously conceived gestations, with complete data regarding obstetric outcome. There were no significant differences in the concentrations of biochemical markers between the analysed groups. Pregnancy-associated plasma protein-A (PAPP-A) levels were lower in hypertensive than in normotensive patients, although the difference was not significant. Twenty-three patients had GDM (12.5%), 16 had GH or PE (8.7%), SGA was diagnosed in 18 (9.8%) and 25 delivered preterm (13.6%).
Conclusions
The trend for lower PAPP-A MoM was visible in all affected patients, although the results did not reach statistical significance. The first trimester biochemical markers in assisted reproduction technique (ART) pregnancies do not seem to have additional effect on predicting the risk of pregnancy complications.
This authoritative textbook provides a much-needed guide for postgraduate trainees preparing for the European Board and College of Obstetrics and Gynaecology (EBCOG) Fellowship examination. Published in association with EBCOG, it fully addresses the competencies defined by the EBCOG curriculum and builds the clinical practice related to these competencies upon the basic science foundations. Volume 1 covers the depth and breadth of obstetrics, and draws on the specialist knowledge of four highly experienced Editors and over 100 contributors from across Europe, reflecting the high-quality training needed to ensure the safety and quality of healthcare for women and their babies. It incorporates key international guidelines throughout, along with colour diagrams and photographs for easy understanding. This is an invaluable resource, not only for postgraduate trainees planning to sit the EFOG examination, but also for practising specialists looking to update their knowledge and skills to meet the ever-evolving complexity of clinical practice.
Background
Data on the relationship between longitudinal changes of maternal volume-dependent echocardiographic parameters and placentation in uncomplicated pregnancy are limited.
Objective
(s): To evaluate changes of volume-dependent echocardiographic parameters in uncomplicated pregnancy. To test the hypothesis of the existence of an association between volume-dependent echocardiographic parameters and Doppler ultrasound parameters of fetal circulation and the uterine artery in uncomplicated pregnancy and to establish which of volume-dependent echocardiographic parameters best depicts volume changes and correlates best with Doppler ultrasound of fetal circulation and the uterine artery in healthy pregnancy.
Study Design
Data from 60 healthy pregnant women were analyzed. A complete echocardiographic study was performed at 11-13, 20-22 and 30-32 weeks of pregnancy: left ventricle end diastolic volume (LVEDV), early diastolic peak flow velocity (E velocity), late diastolic peak flow velocity, left atrium area (LAA) and left atrium volume index (LAVI) were assessed. Obstetrical assessment was performed including: fetal growth, uterine artery pulsatility index (PI). Fetal wellbeing was assessed by umbilical and middle cerebral artery blood flow. Serum pregnancy associated plasma protein A (PAPP-A) and free ß-hCG were assessed during routine first trimester scan (11-13 weeks).
Results
LVEDV and LAA increased significantly between 11-13 and 20-22 weeks but not between 20-22 and 30-32 weeks. LAVI measured at 30-32 weeks correlated with uterine artery pulsatility indices in three trimesters. Changes in LAVI between third and first trimester correlated significantly with UtA PI measured at 20-22 weeks (r=-0.345;p=0.020) and at 30–32 weeks (r=-0.452;p=0.002). Changes in LAVI between second and first trimester significantly correlated with UtA PI measured in the first trimester (r=-0.316;p=0.025).
Conclusion
(s): Our study showed for the first time that in uncomplicated pregnancy among volume-dependent echocardiographic parameters LAVI increased both between first and second as well as second and third trimester and correlated with parameters of Doppler ultrasound of fetal circulation and the uterine artery. Our results expand previous observation on the relationship between maternal cardiovascular adaptation and placentation in women with heart diseases to the population of healthy women with uncomplicated pregnancy.
