Abstract:
BACKGROUND:Preeclampsia (PE) affects 2-3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. The traditional approach to screening for PE is to use a risk-scoring system based on maternal demographic characteristics and medical history (maternal factors), but the performance of such an approach is very poor. OBJECTIVE:To develop a model for PE based on a combination of maternal factors with second-trimester biomarkers. STUDY DESIGN:The data for this study were derived from prospective screening for adverse obstetric outcomes in women attending their routine hospital visit at 19-24 weeks' gestation in 3 maternity hospitals in England between January 2006 and July 2014. We had data from maternal factors, uterine artery pulsatility index (UTPI), mean arterial pressure (MAP), serum placental growth factor (PLGF), and serum soluble fms-like tyrosine kinase-1 (SFLT) from 123,406, 67,605, 31,120, 10,828, and 8079 pregnancies, respectively. Bayes' theorem was used to combine the a priori risk from maternal factors with various combinations of biomarker multiple of the median (MoM) values. The modeled performance of screening for PE requiring delivery at <32, <37, and ≥37 weeks' gestation was estimated. The modeled performance was compared to the empirical one, which was derived from 5-fold cross validation. We also examined the performance of screening based on risk factors from the medical history, as recommended by the American Congress of Obstetricians and Gynecologists (ACOG). RESULTS:In pregnancies that developed PE, the values of MAP, UTPI, and SFLT were increased and PLGF was decreased. For all biomarkers the deviation from normal was greater for early than for late PE, and therefore the performance of screening was inversely related to the gestational age at which delivery became necessary for maternal and/or fetal indications. Screening by maternal factors predicted 52%, 47%, and 37% of PE at <32, <37, and ≥37 weeks' gestation, respectively, at a false-positive rate of 10%. The respective values for combined screening with maternal factors and MAP, UTPI, and PLGF were 99%, 85%, and 46%; the performance was not improved by the addition of SFLT. In our population of 123,406 pregnancies, the DR of PE at <32, <37, and ≥37 weeks with the ACOG recommendations was 91%, 90%, and 91%, respectively, but at a screen positive rate of 67%. CONCLUSION:The performance of screening for PE by maternal factors and biomarkers in the middle trimester is superior to taking a medical history.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Gallo DM,Wright D,Casanova C,Campanero M,Nicolaides KHdoi
10.1016/j.ajog.2015.11.016subject
Has Abstractpub_date
2016-05-01 00:00:00pages
619.e1-619.e17issue
5eissn
0002-9378issn
1097-6868pii
S0002-9378(15)02345-5journal_volume
214pub_type
杂志文章abstract:OBJECTIVE:Our purpose was to study the effects of isradipine, a dihydropyridine calcium channel blocker, on mother and fetus in the treatment of hypertensive disorders of pregnancy. STUDY DESIGN:The investigation was performed as a two-group, parallel, double-blind multicenter study of isradipine versus placebo. Fifty...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9378(95)90357-7
更新日期:1995-09-01 00:00:00
abstract::Fetal heart rate abnormalities associated with prolonged pregnancy have been attributed to umbilical cord vulnerability rather than placental insufficiency. Although intrapartum fetal heart rate patterns indicative of umbilical cord compression are common beyond 41 weeks' gestation, fetal intolerance to labor develops...
journal_title:American journal of obstetrics and gynecology
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abstract:OBJECTIVE:To summarize what is known about satisfaction with childbirth, with particular attention to the roles of pain and pain relief. STUDY DESIGN:A systematic review of 137 reports of factors influencing women's evaluations of their childbirth experiences. The reports included descriptive studies, randomized contr...
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更新日期:1990-07-01 00:00:00
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更新日期:2002-12-01 00:00:00
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更新日期:2018-09-01 00:00:00
abstract::At the Department of Obstetrics and Gynecology of Tohoku University, radical hysterectomy with pelvic lymphadenectomy had been performed on patients with microinvasive carcinoma of the uterine cervix before 1966. Investigation of lymph nodes of 90 patients treated in this manner has shown no lymph node metastasis of t...
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更新日期:2002-10-01 00:00:00
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更新日期:1990-07-01 00:00:00
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更新日期:1982-12-15 00:00:00
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journal_title:American journal of obstetrics and gynecology
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更新日期:1991-07-01 00:00:00
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更新日期:1977-04-15 00:00:00
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更新日期:1985-01-15 00:00:00
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更新日期:1979-08-15 00:00:00
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更新日期:2015-10-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2000-10-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
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更新日期:1984-10-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2001-02-01 00:00:00
abstract::Effect of irradiation alone and irradiation after 5-fluorouracil (5-FU), paclitaxel, or cisplatin (CDDP) was investigated in human cervical cell lines (CaSki, ME180, SiHa, and C33A). High-risk human papillomavirus (HPV) (+) CaSki and SiHa cells were the most resistant to CDDP, 5-FU, and radiation treatments. Radiation...
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更新日期:2005-05-01 00:00:00
abstract:BACKGROUND:Pregnancy-related deaths in the United States are increasing. Medical, social, economic, and cultural issues have all been implicated in this trend, but few data exist to differentiate the relative contributions of these various factors. OBJECTIVE:The objective of the study was to examine trends in US pregn...
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更新日期:2020-05-01 00:00:00
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更新日期:1989-09-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1991-05-01 00:00:00