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1.
Am J Obstet Gynecol ; 214(1): 103.e1-103.e12, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26297382

RESUMEN

BACKGROUND: Preeclampsia affects approximately 3% of all pregnancies and is a major cause of maternal and perinatal morbidity and death. In the last decade, extensive research has been devoted to early screening for preeclampsia with the aim of reducing the prevalence of the disease through pharmacologic intervention in the high-risk group starting from the first trimester of pregnancy. OBJECTIVE: The purpose of this study was to develop a model for preeclampsia based on maternal demographic characteristics and medical history (maternal factors) and biomarkers. STUDY DESIGN: The data for this study were derived from prospective screening for adverse obstetric outcomes in women who attended for their routine first hospital visit at 11-13 weeks gestation in 2 maternity hospitals in England. We screened 35,948 singleton pregnancies that included 1058 pregnancies (2.9%) that experienced preeclampsia. Bayes theorem was used to combine the a priori risk from maternal factors with various combinations of uterine artery pulsatility index, mean arterial pressure, serum pregnancy-associated plasma protein-A, and placental growth factor multiple of the median values. Five-fold cross validation was used to assess the performance of screening for preeclampsia that delivered at <37 weeks gestation (preterm-preeclampsia) and ≥37 weeks gestation (term-preeclampsia) by models that combined maternal factors with individual biomarkers and their combination with screening by maternal factors alone. RESULTS: In pregnancies that experienced preeclampsia, the values of uterine artery pulsatility index and mean arterial pressure were increased, and the values of serum pregnancy-associated plasma protein-A and placental growth factor were decreased. For all biomarkers, the deviation from normal was greater for early than late preeclampsia; therefore, the performance of screening was related inversely to the gestational age at which delivery became necessary for maternal and/or fetal indications. Combined screening by maternal factors, uterine artery pulsatility index, mean arterial pressure, and placental growth factor predicted 75% (95% confidence interval, 70-80%) of preterm-preeclampsia and 47% (95% confidence interval, 44-51%) of term-preeclampsia, at a false-positive rate of 10%; inclusion of pregnancy-associated plasma protein-A did not improve the performance of screening. Such detection rates are superior to the respective values of 49% (95% confidence interval, 43-55%) and 38% (34-41%) that were achieved by screening with maternal factors alone. CONCLUSION: Combination of maternal factors and biomarkers provides effective first-trimester screening for preterm-preeclampsia.


Asunto(s)
Modelos Estadísticos , Preeclampsia/diagnóstico , Preeclampsia/fisiopatología , Primer Trimestre del Embarazo/fisiología , Adulto , Presión Arterial , Teorema de Bayes , Biomarcadores/sangre , Parto Obstétrico , Reacciones Falso Positivas , Femenino , Edad Gestacional , Humanos , Paridad , Factor de Crecimiento Placentario , Preeclampsia/sangre , Valor Predictivo de las Pruebas , Embarazo , Proteínas Gestacionales/sangre , Primer Trimestre del Embarazo/sangre , Proteína Plasmática A Asociada al Embarazo/metabolismo , Estudios Prospectivos , Flujo Pulsátil , Medición de Riesgo , Factores de Riesgo , Ultrasonografía , Arteria Uterina/diagnóstico por imagen , Arteria Uterina/fisiopatología
2.
Am J Obstet Gynecol ; 213(1): 62.e1-62.e10, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25724400

RESUMEN

OBJECTIVE: The purpose of this study was to develop a model for preeclampsia based on maternal demographic characteristics and medical history. STUDY DESIGN: This was a screening study of 120,492 singleton pregnancies at 11-13 weeks' gestation, including 2704 pregnancies (2.2%) that experienced preeclampsia. A survival-time model for the gestational age at delivery with preeclampsia was developed from variables of maternal characteristics and history. This approach assumes that, if the pregnancy was to continue indefinitely, all women would experience preeclampsia and that whether they do so or not before a specified gestational age depends on competition between delivery before or after development of preeclampsia. A 5-fold cross validation study was conducted to compare the performance of the new model with the National Institute for Health and Clinical Excellence (NICE) guidelines. RESULTS: In the new model, increased risk for preeclampsia, with a consequent shift in the Gaussian distribution of the gestational age at delivery with preeclampsia to the left, is provided by advancing maternal age, increasing weight, Afro-Caribbean and South Asian racial origin, medical history of chronic hypertension, diabetes mellitus and systemic lupus erythematosus or antiphospholipid syndrome, family history and personal history of preeclampsia, and conception by in vitro fertilization. The risk for preeclampsia decreases with increasing maternal height and in parous women with no previous preeclampsia; in the latter, the protective effect, which is related inversely to the interpregnancy interval, persists beyond 15 years. At a screen-positive rate of 11%, as defined by NICE, the new model predicted 40%, 48%, and 54% of cases of total preeclampsia and preeclampsia requiring delivery at <37 and <34 weeks' gestation, respectively, which were significantly higher than the respective values of 35%, 40%, and 44% achieved by application of NICE guidelines. CONCLUSION: A new model that is based on maternal characteristics and medical history has been developed for the estimation of patient-specific risks for preeclampsia. Such estimation of the a priori risk for preeclampsia is an essential first step in the use of Bayes theorem to combine maternal factors with biomarkers for the continuing development of more effective methods of screening for the disease.


Asunto(s)
Preeclampsia/diagnóstico , Teorema de Bayes , Diabetes Mellitus/epidemiología , Femenino , Fertilización In Vitro , Humanos , Edad Materna , Preeclampsia/epidemiología , Preeclampsia/etnología , Embarazo , Medición de Riesgo , Factores de Riesgo
3.
J Matern Fetal Neonatal Med ; 28(8): 954-8, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25072837

RESUMEN

INTRODUCTION: Acute pancreatitis is a recognised rare complication in pregnancy. The reported incidence varies between 3 and 7 in 10 000 pregnancies and is higher in the third trimester. The commonest causes in pregnancy include gallstones, alcohol and hypertriglyceridaemia. Non-gallstone pancreatitis is associated with more complications and poorer outcome with hypertriglyceridaemia-induced acute pancreatitis having mortality rates ranging from 7.5 to 9.0% and 10.0 to 17.5% for mother and foetus, respectively. CASE HISTORY: A 40-year-old para 4 woman, who presented at 15(+4) weeks' gestation, was diagnosed with acute pancreatitis. Past medical history included Graves' disease and hypertriglyceridaemia. Fenofibrate was discontinued immediately after discovery of the pregnancy. Initial investigations showed elevated amylase (475.0 µ/L) and triglycerides (46.6 mmol/L). Imaging revealed an inflamed pancreas without evidence of biliary obstruction/gallstones hence confirming the diagnosis of hypertriglyceridaemia-induced acute pancreatitis. Laboratory tests gradually improved (triglyceride 5.2 mmol/L on day 17). On day 18, ultrasound confirmed foetal demise (18(+1) weeks) and a hysterotomy was performed as she had had four previous caesarean sections. CONCLUSION: Management of acute pancreatitis in pregnancy requires a multi-disciplinary approach. Hypertriglyceridaemia-induced acute pancreatitis has poor outcomes when diagnosed in early pregnancy. Identifying those at risk pre-pregnancy and antenatally can allow close monitoring through pregnancy to optimise care.


Asunto(s)
Hipertrigliceridemia/complicaciones , Pancreatitis/diagnóstico , Complicaciones del Embarazo/diagnóstico , Adulto , Femenino , Muerte Fetal , Humanos , Pancreatitis/etiología , Pancreatitis/terapia , Embarazo , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/terapia
4.
J Matern Fetal Neonatal Med ; 28(8): 865-8, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-24953352

RESUMEN

OBJECTIVE: To investigate the potential value of maternal serum anti-Müllerian hormone (AMH) at 11-13 weeks' gestation in the prediction of preeclampsia (PE). METHODS: The serum concentration of AMH was measured at 11-13 weeks' gestation in cases of PE (n = 50) and normotensive controls (n = 150). Backward stepwise multiple regression analysis was used to determine which of the factors amongst the maternal characteristics and gestation were significant predictors of the serum AMH in the control group and from the regression model the value in each case and control was expressed as a multiple of the expected median (MoM). RESULTS: In normotensive pregnancies, the maternal serum concentration of AMH is higher in Afro-Caribbean than in Caucasian women and in smokers than in non-smokers. In the PE group, the median serum concentration of AMH was significantly higher than in the controls (2.140 ng/L, IQR 1.968-2.273 versus 2.062 ng/L, IQR 1.938-2.181; p = 0.025), but the median MoM value of AMH was not significantly different between the PE group and the controls (1.040, IQR 0.941-1.081 versus 0.995, IQR 0.939-1.065, p = 0.147). CONCLUSIONS: Maternal serum AMH is not an effective early predictor for PE.


Asunto(s)
Hormona Antimülleriana/sangre , Preeclampsia/diagnóstico , Primer Trimestre del Embarazo/sangre , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Preeclampsia/sangre , Embarazo , Estudios Prospectivos , Análisis de Regresión
5.
J Matern Fetal Neonatal Med ; 28(5): 535-9, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-24827601

RESUMEN

OBJECTIVE: To define the maternal demographic factors that predicts the risk of developing early-onset pre-eclampsia (requiring delivery before 34 weeks' gestation) in an Australian population. These are compared to risk factors described in a British population to determine whether the Fetal Medicine Foundation (FMF) risk algorithm for predicting early-onset pre-eclampsia needs to be modified for an Australian population. METHODS: A secondary analysis of prospective cohorts in Australia and in the United Kingdom was conducted. Demographic details and past medical history were obtained. Odds ratios (ORs) for the development of early-onset pre-eclampsia were calculated for maternal factors in both populations. Forest plots were used to compare the two sets of odds ratios. RESULTS: In the Australian population, pre-existing hypertension (OR 19.89, 95% CI 4.17-94.93) and body mass index >40 kg/m(2) (OR 9.04, 95% CI 1.13-72.40) predicted risk of developing early-onset pre-eclampsia. There were no significant differences in the odds ratios for maternal factors in the two populations. CONCLUSIONS: This study shows that the ORs used to describe risks associated with maternal characteristics in the FMF algorithm for early-onset pre-eclampsia are consistent with those found in our local population. There does not appear to be any value in changing the weighting of demographic factors included in the FMF algorithm for an Australian population.


Asunto(s)
Edad Gestacional , Preeclampsia/epidemiología , Preeclampsia/etiología , Adulto , Edad de Inicio , Australia/epidemiología , Demografía , Femenino , Humanos , Embarazo , Pronóstico , Factores de Riesgo , Reino Unido/epidemiología , Adulto Joven
6.
Obstet Gynecol Int ; 2014: 297397, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25136369

RESUMEN

Effective screening for the development of early onset preeclampsia (PE) can be provided in the first-trimester of pregnancy. Screening by a combination of maternal risk factors, uterine artery Doppler, mean arterial pressure, maternal serum pregnancy-associated plasma protein-A, and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.

7.
Fetal Diagn Ther ; 36(1): 9-17, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24902880

RESUMEN

OBJECTIVE: To assess the risk for preeclampsia (PE) by maternal characteristics, uterine artery pulsatility index (Ut-PI), mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) at 30-33 weeks' gestation. METHODS: This was a screening study in singleton pregnancies including 2,140 that developed PE and 83,615 that were unaffected by PE. We developed a survival time model for the time of delivery for PE by combining maternal characteristics and history with Ut-PI, MAP, PlGF and sFlt-1 multiple of the median (MoM) values (combined test). Data on third-trimester MAP and Ut-PI were available in 350 cases of PE, and 13,878 unaffected pregnancies and data on PlGF and sFlt-1 were available in 118 cases of PE and 3,734 unaffected pregnancies. Modelled detection rate of all PE and PE requiring delivery within 4 and 6 weeks of the visit was estimated. RESULTS: Screening by the combined test would detect 66, 98 and 86% of all PE and PE requiring delivery within 4 and 6 weeks of the visit, respectively, at a false positive rate of 5%. INTERPRETATION: Screening by biophysical and biochemical testing at 30-33 weeks could identify most pregnancies developing PE and requiring delivery within the subsequent 4 weeks.


Asunto(s)
Edad Gestacional , Modelos Biológicos , Preeclampsia/sangre , Preeclampsia/diagnóstico , Tercer Trimestre del Embarazo/sangre , Diagnóstico Prenatal/métodos , Adulto , Biomarcadores/sangre , Femenino , Humanos , Modelos Lineales , Factor de Crecimiento Placentario , Embarazo , Proteínas Gestacionales/sangre , Estudios Prospectivos , Factores de Riesgo
8.
Fetal Diagn Ther ; 36(1): 18-27, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24970282

RESUMEN

OBJECTIVE: To assess risk for preeclampsia (PE) based on maternal characteristics, mean arterial pressure (MAP) and uterine artery pulsatility index (Ut-PI) at 30-33 weeks' gestation. METHODS: Screening study in singleton pregnancies including 2,140 that subsequently developed PE and 83,615 that were unaffected by PE, gestational hypertension or delivery of small-for-gestational-age neonates (normal group). We developed a survival time model for the time of delivery for PE by combination of maternal characteristics and history with MAP and Ut-PI multiple of the median (MoM) values (biophysical test). Data on third-trimester MAP and Ut-PI were available in 350 cases of PE and 13,878 of the normal group. The detection rate of PE requiring delivery within 4, 6 and 8 weeks of the visit was estimated. RESULTS: In pregnancies with PE the log10 MoM values of MAP and Ut-PI were inversely related to gestational age at delivery. Biophysical testing detected 90, 65 and 53% of PE with delivery within 4, 6 and 8 weeks of the visit, at a fixed false-positive rate of 5%. INTERPRETATION: Testing by maternal characteristics, Ut-PI and MAP at 30-33 weeks could identify 90% of pregnancies developing PE and requiring delivery within the subsequent 4 weeks.


Asunto(s)
Presión Arterial/fisiología , Modelos Biológicos , Preeclampsia/diagnóstico , Primer Trimestre del Embarazo/fisiología , Flujo Pulsátil/fisiología , Arteria Uterina/fisiología , Adulto , Femenino , Edad Gestacional , Humanos , Preeclampsia/fisiopatología , Embarazo , Diagnóstico Prenatal/métodos , Estudios Prospectivos
9.
Fetal Diagn Ther ; 35(4): 240-8, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24853452

RESUMEN

OBJECTIVE: To assess the risk for preeclampsia (PE) by maternal characteristics, serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) at 30-33 weeks' gestation. METHODS: This was a screening study in singleton pregnancies including 2,140 that subsequently developed PE and 83,615 that were unaffected by PE, gestational hypertension or delivery of small-for-gestational-age neonates (normal group). We developed a survival time model for the time of delivery for PE by combination of maternal characteristics and history with PlGF and sFlt-1 multiple of the median (MoM) values (biochemical test). Data on third-trimester PlGF and sFlt-1 were available in 118 cases of PE and 3,734 of normal group. The detection rate (DR) of PE requiring delivery within 4, 6 and 8 weeks of the visit was estimated. RESULTS: In pregnancies with PE, the log10 MoM values of PlGF and sFlt-1 were linearly related to gestational age at delivery. Screening by the biochemical test detected 100, 76, and 62% of PE with delivery within 4, 6 and 8 weeks of the visit, at a fixed false-positive rate of 5%. INTERPRETATION: Testing by PlGF and sFlt-1 at 30-33 weeks could identify all pregnancies developing PE and requiring delivery within the subsequent 4 weeks.


Asunto(s)
Preeclampsia/diagnóstico , Proteínas Gestacionales/sangre , Receptor 1 de Factores de Crecimiento Endotelial Vascular/sangre , Adulto , Biomarcadores/sangre , Femenino , Edad Gestacional , Humanos , Factor de Crecimiento Placentario , Preeclampsia/sangre , Embarazo , Resultado del Embarazo , Tercer Trimestre del Embarazo/sangre , Análisis de Regresión , Medición de Riesgo
10.
Prenat Diagn ; 34(7): 618-27, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24764257

RESUMEN

Preeclampsia (PE), which affects about 2% of pregnancies, is a major cause of maternal and perinatal morbidity and mortality. PE can be subdivided into early onset PE with delivery <34 weeks' gestation and late onset PE with delivery ≥34 weeks. Early onset PE is associated with a higher incidence of adverse outcome. This review illustrates that effective screening for the development of early onset PE can be provided in the first-trimester of pregnancy. Screening by a combination of maternal risk factors, mean arterial pressure, uterine artery Doppler, maternal serum pregnancy-associated plasma protein-A and placental growth factor can identify about 95% of cases of early onset PE for a false-positive rate of 10%.


Asunto(s)
Biomarcadores/sangre , Preeclampsia/diagnóstico , Preeclampsia/etiología , Primer Trimestre del Embarazo/sangre , Diagnóstico Prenatal , Femenino , Humanos , Madres , Preeclampsia/sangre , Embarazo , Diagnóstico Prenatal/métodos , Historia Reproductiva , Factores de Riesgo
11.
Fetal Diagn Ther ; 35(4): 267-79, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24751835

RESUMEN

INTRODUCTION: The objective of this study was to define the optimal method and timing of intervention in twin reversed arterial perfusion (TRAP) sequence. MATERIAL AND METHODS: During a period of 20 years (1993-2013), we performed endoscopic laser coagulation of umbilical cord vessels or intrafetal laser in 67 pregnancies with TRAP sequence. These data were combined with those reported in the literature to determine the survival rate of the pump twin for different methods and timing of interventions. RESULTS: A variety of techniques were used to interrupt the blood supply to the acardiac twin. Most procedures were performed at or after 16 weeks, and with most methods the survival rate of the pump twin was about 80%. Good results were also obtained for triplet pregnancies. In 18 of 30 cases (60%) diagnosed at 11-14 weeks, there was spontaneous cessation of flow in the acardiac twin before planned intervention at 16-18 weeks, and in 11 of these (61.1%) the pump twin died or suffered brain damage. In 103 pregnancies treated by intrafetal laser at 12-27 weeks, there was no correlation between gestational age at treatment and survival rate, but there was an inverse association between gestational age at treatment and gestational age at birth. DISCUSSION: In TRAP sequence, survival may be improved by elective intervention at 12-14 weeks.


Asunto(s)
Enfermedades en Gemelos/cirugía , Fetoscopía/métodos , Embarazo Gemelar , Cordón Umbilical/cirugía , Enfermedades en Gemelos/mortalidad , Femenino , Fetoscopía/mortalidad , Humanos , Coagulación con Láser/métodos , Embarazo , Medición de Riesgo , Tasa de Supervivencia , Factores de Tiempo
12.
Fetal Diagn Ther ; 36(1): 28-37, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24752037

RESUMEN

OBJECTIVES: To assess the performance of screening for preeclampsia (PE) by mean arterial pressure (MAP) at 11-13 and at 20-24 weeks' gestation. METHODS: MAP was measured at 11-13 and 20-24 weeks in 17,383 singleton pregnancies, including 70 with early PE, requiring delivery <34 weeks' gestation, 143 with preterm PE, delivering <37 weeks and 537 with total PE. MAP was expressed as multiple of the median (MoM) after adjustment for maternal characteristics and corrected for adverse pregnancy outcomes. The performance of screening for PE by maternal characteristics and MAP MoM at 11-13 weeks (MAP-1), MAP MoM at 20-24 weeks (MAP-2) and their combination was evaluated. RESULTS: In screening by maternal characteristics and MAP-1, at a false-positive rate (FPR) of 10%, the detection rates (DR) of early PE, preterm PE and total PE were 74.3, 62.9 and 49.3%, respectively; the DR at FPR of 5% were 52.9, 42.7 and 35.8%. In screening by MAP-1 and MAP-2 the DR at FPR of 10%, were 84.3, 65.7 and 52.5%; the DR at FPR of 5% were 60.0, 49.7 and 37.6%, respectively. CONCLUSIONS: Performance of screening for PE by MAP is best when measurements are taken at both 11-13 and 20-24 weeks' gestation than at only one of these gestational ranges.


Asunto(s)
Presión Arterial/fisiología , Edad Gestacional , Preeclampsia/diagnóstico , Primer Trimestre del Embarazo/fisiología , Segundo Trimestre del Embarazo/fisiología , Adulto , Femenino , Humanos , Preeclampsia/fisiopatología , Valor Predictivo de las Pruebas , Embarazo , Estudios Prospectivos
13.
Fetal Diagn Ther ; 35(4): 249-57, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24642536

RESUMEN

OBJECTIVE: To compare the maternal serum concentrations of placental growth factor (PlGF)-1 and PlGF-2 in the first, second and third trimesters in normal pregnancies and in those complicated by pre-eclampsia (PE) or the delivery of small for gestational age (SGA) neonates after 37 weeks. METHODS: Serum PlGF-1 and PlGF-2 were measured at 11-13, 20-24 and 30-34 weeks' gestation in 50 cases of PE, 99 cases of SGA and 298 controls. The values of PlGF-1 and PlGF-2 at 11-13 weeks were expressed as multiples of the median (MoM) after adjustment for maternal characteristics. The distributions of PlGF-1 and PlGF-2 in cases and controls at 20-24 and 30-34 weeks were converted to MoM of the values at 11-13 weeks and compared. RESULTS: Serum PlGF-1 and PlGF-2 levels were highly correlated and both increased with gestational age. At 30-34 weeks, the median MoM values for PlGF-1 and PlGF-2 in the late PE (4.2 and 4.3) and late SGA (7.2 and 6.0) groups were significantly lower than in the controls (12.8 and 9.9). Combining the two isoforms did not improve the prediction of late PE and late SGA provided by PlGF-1 alone. CONCLUSIONS: The performances of serum PlGF-1 and PlGF-2 in the prediction of late PE and late SGA are similar.


Asunto(s)
Preeclampsia/sangre , Proteínas Gestacionales/sangre , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Recién Nacido Pequeño para la Edad Gestacional , Factor de Crecimiento Placentario , Embarazo , Resultado del Embarazo , Primer Trimestre del Embarazo/sangre , Segundo Trimestre del Embarazo/sangre , Tercer Trimestre del Embarazo/sangre , Isoformas de Proteínas/sangre
14.
Fetal Diagn Ther ; 36(2): 106-16, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24457972

RESUMEN

OBJECTIVE: To compare the maternal serum concentration of placental growth factor-1 (PlGF-1) and PlGF-2 at 11-13 weeks' gestation in normal pregnancies and in those complicated by preeclampsia (PE), delivery of small for gestational age (SGA) neonates and fetal trisomies 21, 18 and 13. METHODS: Serum PlGF-1 and PlGF-2 were measured in 270 pathological pregnancies (PE, n = 80; SGA, n = 80; trisomy 21, n = 44; trisomy 18, n = 38; trisomy 13, n = 28) and 590 normal controls. The values were expressed as multiple of the median (MoM) after adjustment for maternal characteristics and corrected for adverse pregnancy outcomes and the median MoM values in each pathological pregnancy were compared to the normal group. RESULTS: There were significant contributions to PlGF-1 and PlGF-2 from gestational age, smoking and racial origin. In addition, there were significant contributions to PlGF-1 from parity and method of conception. The median MoM of PlGF-1 and PlGF-2 was significantly decreased in PE (0.783 and 0.916 MoM), SGA (0.891 and 0.851 MoM), trisomy 21 (0.609 and 0.749 MoM), trisomy 18 (0.529 and 0.730 MoM) and trisomy 13 (0.373 and 0.699 MoM). CONCLUSIONS: In pathological pregnancies, except SGA, the decrease in serum PlGF-1 at 11-13 weeks' gestation is more marked than the decrease in PlGF-2.


Asunto(s)
Retardo del Crecimiento Fetal/sangre , Preeclampsia/sangre , Proteínas Gestacionales/sangre , Primer Trimestre del Embarazo/sangre , Isoformas de Proteínas/sangre , Adulto , Estudios de Casos y Controles , Trastornos de los Cromosomas/sangre , Femenino , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Factor de Crecimiento Placentario , Embarazo , Resultado del Embarazo , Encuestas y Cuestionarios
15.
Fetal Diagn Ther ; 34(4): 241-7, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24192614

RESUMEN

OBJECTIVES: To determine maternal characteristics affecting uterine artery pulsatility index (PI) in normal pregnancies at 20-24 weeks' gestation and examine in pregnancies with preeclampsia (PE) the relation between uterine artery PI multiple of the median (MoM) and severity of disease. METHODS: Uterine artery PI was measured at 20-24 weeks in 50,490 singleton pregnancies, including 1,442 (2.9%) that developed PE. Uterine artery PI was expressed as MoM after adjustment for maternal characteristics and corrected for adverse pregnancy outcomes. In PE, the correlation between uterine artery PI MoM with gestational age at delivery and birth weight Z-score was determined. RESULTS: In the normal group there were significant independent contributions to uterine artery PI from gestational age, racial origin and prior history of PE, and/or small for gestational age (SGA). In the PE group, there was an inverse significant association between uterine artery PI MoM and both gestational age at delivery and birth weight Z-score (p < 0.0001). Uterine artery PI was above the 95th percentile (1.509 MoM) in 72.7, 36.1 and 14.9% of cases of PE requiring delivery at <34, 34-37 and ≥38 weeks, respectively, and the percentages for PE with SGA were 80.2, 55.6 and 37.4%. CONCLUSIONS: In a normal pregnancy, uterine artery PI is affected by maternal characteristics, and in PE, uterine artery PI MoM is related to the severity of the disease.


Asunto(s)
Preeclampsia/diagnóstico por imagen , Arteria Uterina/diagnóstico por imagen , Adulto , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Preeclampsia/diagnóstico , Preeclampsia/fisiopatología , Valor Predictivo de las Pruebas , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Diagnóstico Prenatal , Estudios Prospectivos , Flujo Pulsátil , Ultrasonografía Doppler , Arteria Uterina/fisiopatología
16.
Aust N Z J Obstet Gynaecol ; 53(6): 532-9, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23919594

RESUMEN

BACKGROUND: The aim of this study is to validate the Fetal Medicine Foundation (FMF) multiple logistic regression algorithm for prediction of risk of pre-eclampsia in an Australian population. This model, which predicts risk using the population rate of pre-eclampsia, a variety of demographic factors, mean maternal arterial blood pressure (MAP), uterine artery PI (UtA PI) and pregnancy-associated plasma protein A (PAPP-A), has been shown to predict early-onset pre-eclampsia (delivery prior to 34 weeks) in 95% of women at a 10% false-positive rate. METHODS: All women who attended first trimester screening at the Royal Prince Alfred Hospital had their body mass index (BMI), MAP and UtA PI assessed in addition to factors traditionally used to assess aneuploidy (including PAPP-A MoM). After delivery, risks of early-onset (delivery prior to 34 weeks) pre-eclampsia, late pre-eclampsia and gestational hypertension were calculated using the FMF risk algorithm. RESULTS: A total of 3099 women were screened and delivered locally. 3066 (98.9%) women had all data to perform pre-eclampsia screening available. This included 3014 (98.3%) women with a live birth, where risks of early pre-eclampsia were calculated. Twelve women were delivered before 34 weeks because of early pre-eclampsia with a prevalence of early pre-eclampsia of 1 in 256 pregnancies. Risks generated through the use of maternal history, MAP, UtA PI and PAPP-A detected 41.7 and 91.7% of early pre-eclampsia at a false-positive rate of 5 and 10%, respectively. CONCLUSIONS: This study shows that the FMF early pre-eclampsia algorithm is effective in an Australian population.


Asunto(s)
Algoritmos , Presión Arterial , Preeclampsia/diagnóstico , Proteína Plasmática A Asociada al Embarazo/metabolismo , Arteria Uterina/fisiología , Área Bajo la Curva , Australia , Biomarcadores/sangre , Diagnóstico Precoz , Reacciones Falso Positivas , Femenino , Edad Gestacional , Humanos , Paridad , Embarazo , Primer Trimestre del Embarazo , Flujo Pulsátil , Curva ROC , Recurrencia , Estudios Retrospectivos , Medición de Riesgo
17.
Fetal Diagn Ther ; 34(1): 50-5, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23711954

RESUMEN

OBJECTIVE: To investigate the potential value of prefrontal space ratio (PFSR) in second-trimester screening for trisomy-21. METHODS: A retrospective study utilizing stored midsagittal two-dimensional images of fetal profiles in 240 euploid and 45 trisomy-21 pregnancies at 16(+0)-23(+6) weeks' gestation. The vertical distance between the leading edge of the skull and that of the skin (D1) and the distance between the skull and the mandibulo-maxillary line (D2) were measured and the D1:D2 ratio (PFSR) was calculated. In euploid pregnancies, regression analysis was used to determine the association between D1, D2 and PFSR with gestational age (GA). D1 and D2 were expressed as delta (Δ) values with gestational age. ΔD1, ΔD2 and PFSR in cases and controls were compared. RESULTS: In trisomy-21, compared to controls, ΔD1 was increased (1.417 vs. 0.000 mm, p < 0.0001), ΔD2 was decreased (-0.842 vs. 0.000 mm, p = 0.003) and PFSR was increased (0.753 vs. 0.463, p < 0.0001). At a false-positive rate of 5%, the detection rates in screening by ΔD1, ΔD2 and PSFR were 80.0% (95% CI 65.4-90.4), 46.7% (95% CI 31.7-62.1) and 100.0% (95% CI 92.1-100.0), respectively. CONCLUSION: The PFSR is an effective marker in second-trimester screening for trisomy-21.


Asunto(s)
Síndrome de Down/diagnóstico por imagen , Cabeza/diagnóstico por imagen , Segundo Trimestre del Embarazo , Adolescente , Adulto , Síndrome de Down/genética , Femenino , Marcadores Genéticos , Humanos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Variaciones Dependientes del Observador , Embarazo , Segundo Trimestre del Embarazo/genética , Estudios Retrospectivos , Ultrasonografía Prenatal/métodos , Adulto Joven
18.
Thyroid ; 23(9): 1165-71, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23659690

RESUMEN

BACKGROUND: Thyroid disease during pregnancy may be associated with increased risk of various pregnancy complications. It is known that serum thyrotropin (TSH) is suppressed because of the increased hormone production induced by human chorionic gonadotrophin (hCG) in early pregnancy, and that higher hCG levels in twin pregnancies may cause a more pronounced physiologic suppression. The recognition of this phenomenon is important in order to avoid unnecessary concerns and to correctly establish the diagnosis of overt thyroid disease in twin pregnancies. The aim of this study was to establish reference ranges of maternal serum TSH and free thyroxine (FT4) at gestational weeks 11-13 in twin pregnancies. METHODS: This is a case series of 177 dichorionic and 58 monochorionic twin pregnancies with normal outcomes, and 19 monochorionic pregnancies complicated by severe twin-twin transfusion syndrome. Maternal serum concentrations of TSH, FT4, antithyroperoxidase, and antithyroglobulin antibodies were measured at gestational weeks 11-13. The measured TSH and FT4 were converted to multiple of median (MoM) of normal singleton pregnancies and MoM values in the different groups were compared. RESULTS: In the antibody-negative twin pregnancies with normal outcomes, compared to singletons, serum TSH MoM was lower (median 0.62 [interquartile range [IQR 0.16-1.18] vs. 1.01 [IQR 0.61-1.51]; p < 0.0001), FT4 MoM was not significantly different (median 0.98 [IQR 0.91-1.08] vs. 0.99 [IQR 0.91-1.09]; p = 0.975), and free ß-hCG MoM was higher (median 1.91 [IQR 1.33-2.59] vs. 0.98 [IQR 0.66-1.50]; p < 0.0001). In the antibody-positive group (n = 37), compared to the negative group (n = 198), the median TSH was higher, but FT4 and free ß-hCG were not significantly different. In the twin-twin transfusion syndrome group, compared to normal twin pregnancies, TSH, FT4, and free ß-hCG were not significantly different. CONCLUSION: In twins, compared to singleton pregnancies, TSH is lower but FT4 is not significantly different. These reference ranges of thyroid hormones in twins can form the basis for the study of early thyroid function in pathological pregnancies and the investigation of the consequences of overt and subclinical hypothyroidism on twin pregnancy outcome.


Asunto(s)
Embarazo Gemelar/sangre , Pruebas de Función de la Tiroides , Glándula Tiroides/metabolismo , Gemelos Dicigóticos , Gemelos Monocigóticos , Autoanticuerpos/sangre , Biomarcadores/sangre , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Femenino , Transfusión Feto-Fetal/sangre , Transfusión Feto-Fetal/diagnóstico , Edad Gestacional , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/diagnóstico , Valor Predictivo de las Pruebas , Embarazo , Complicaciones del Embarazo/sangre , Complicaciones del Embarazo/diagnóstico , Embarazo Gemelar/inmunología , Valores de Referencia , Pruebas de Función de la Tiroides/normas , Glándula Tiroides/inmunología , Tirotropina/sangre , Tirotropina/inmunología , Tiroxina/sangre
19.
Prenat Diagn ; 33(9): 823-30, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23591998

RESUMEN

OBJECTIVE: The aim of this case-control study at 30-33 weeks, a few days or weeks before the clinical onset of preeclampsia (PE), was to assess whether serum concentrations of cytokines differ between patients who are destined to develop PE and those with uncomplicated pregnancies. METHODS: A panel of cytokines was measured using Luminex technology at 30-33 weeks' gestation in 39 cases that developed PE at or after 34 weeks and 117 unaffected controls. RESULTS: The serum concentrations of most analysed cytokines were no different in women who developed PE than in controls. The proportions of women with detectable concentrations of MIP-1α and IL-8 were significantly lower in those with PE than in the controls (MIP-1α: 14/39 vs 76/117, P = 0.003; IL-8:13/39 vs 83/117, P < 0.0001). The median maternal serum concentration of IL-1ß was significantly lower in the PE cases than in the controls (0.38 pg/mL, range 0.01-0.92, vs 0.60 pg/mL, range 0.02-3.54, P = 0.005). CONCLUSION: Our findings do not lend support to the hypothesis that systemic inflammation precedes the onset of PE or that cytokines are good markers for such inflammation and certainly the panel of cytokines we examined does not provide useful prediction of subsequent development of PE.


Asunto(s)
Citocinas/sangre , Preeclampsia/diagnóstico , Tercer Trimestre del Embarazo/sangre , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Mediadores de Inflamación/sangre , Madres , Preeclampsia/sangre , Embarazo , Pronóstico
20.
Fetal Diagn Ther ; 33(3): 156-63, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23445882

RESUMEN

OBJECTIVE: To investigate the potential value of measuring uterine artery pulsatility index (PI) at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. METHODS: Screening study in singleton pregnancies at 30-33 weeks' gestation including 4,294 cases that were unaffected by PE, gestational hypertension (GH) or delivery of small for gestational age neonates (normal group), 145 that subsequently developed PE, with 37 cases requiring delivery at 34-37 weeks (intermediate-PE) and 108 delivering at or after 38 weeks (late-PE) and 161 that developed GH. The a priori risks for intermediate- and late-PE from maternal demographic characteristics and medical history were derived by logistic regression analysis. The a posteriori risks were calculated by combining the a priori risks with the likelihood ratios for uterine artery PI, which were calculated from fitted bivariate gaussian distributions. RESULTS: In screening for PE by a combination of maternal characteristics and uterine artery PI, the estimated detection rates of intermediate- and late-PE, at a false-positive rate of 10%, were 70.3 and 54.6%, respectively. CONCLUSION: Combined testing by maternal characteristics and uterine artery PI at 30-33 weeks could effectively identify women at high risk for subsequent development of PE.


Asunto(s)
Preeclampsia/diagnóstico por imagen , Tercer Trimestre del Embarazo , Arteria Uterina/diagnóstico por imagen , Adulto , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Flujo Pulsátil , Ultrasonografía , Arteria Uterina/fisiopatología
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