RCOG World Congress 2023

Introduction: Preeclampsia (PE) is a multisystem disorder of pregnancy comprising of onset of hypertension with significant proteinuria after 20 weeks’ gestation in a previously normotensive woman. It has various short term and long term maternal and fetal adverse effects making it imperative to have an effective screening tool in place.

Aims and Objectives: To analyze the relative efficacy of different FTS methods for prediction of pre-eclampsia.

Methodology:

Retrospective observational study from August 2021 to February 2022 on women who underwent enhanced FTS in a tertiary care center to study the outcomes and analyze the best screening methodology.
Enhanced FTS comprises of maternal risk factors, Mean arterial blood pressure, Uterine artery Doppler (UAD) measurement & serum biomarkers (PaPP-A, PlGF) between 11 to 13+6 weeks of gestation. A risk of 1:100 was used to consider a result as screen positive.
Delivery outcomes were analyzed
Screen positive patients (by history, low PaPP-A or high uterine artery pulsatility index) were started on prophylactic low dose aspirin of 150 mg once daily.

Results:

286 women were screened, of which 35 women were lost to follow-up and data was analyzed for 251 women

11.95% women screened positive on FTS of which 3 women screened positive for early PE all of whom developed severe preeclampsia <28 weeks with IUFD
One woman who developed PE<34 weeks, screened negative by all methods but had a history of Covid-19 infection between 16 to 18 weeks of pregnancy
12.75% women screened positive on UAD of which 37.5% developed adverse outcomes.
3 patients who were UAD positive but FTS screen negative developed FGR but not PE.
16.73% women screened positive by history of which only 21.43% developed adverse outcomes.
In 4 women who were screen negative by FTS but screen positive by history, 3 developed PE and 1 woman had FGR. All these 4 women were screen negative by UAD and low PaPP-A as well
3.18% women screened positive by low PaPP-A of which 2 women developed adverse outcomes (1 PE and 1 FGR- screen negative by all other methods)

Conclusion:

With respect to early onset PE, FTS had a sensitivity & specificity of 75% & 100% respectively
UAD seems to be having a role in prediction of FGR
Screening by history is still relevant
7 women developed late onset PE not picked up by any first trimester screening method which emphasizes the relevance of ongoing screening
Almost 66.7% of the women in the enhanced FTS group developed various placental complications.

RCOG World Congress 2023

Efficacy of enhanced first trimester screening (FTS) in prediction of preeclampsia.

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