First Trimester Screening for Pre-eclampsia and Fetal Growth Restriction

This paper is an analysis of the effectiveness of various first trimester markers in detecting uteroplacental insufficiency. The various parameters used for screening in 3373 women were uterine artery pulsatility index (PI) > 90th percentile, maternal characteristics, mean arterial pressure (MAP), PAPP-A lower than 0.5 MoM, and PlGF test. Adverse pregnancy outcomes related to uteroplacental insufficiency, namely low birth weight, fetal loss, delivery before 36 weeks (due to abnormal fetal Doppler or oligohydramnios), and hypertension were assessed. Adverse outcomes were found in 37 % of patients who had high uterine PI, in 52 % of cases that had a positive risk after inclusion of maternal characteristics, MAP, and uterine artery Doppler, 55 % of women with low PAPP-A values, 85 % in cases that had both low PAPP-A values and high uterine artery PI, in all the cases positive for early onset pre-eclampsia (PE), and in 65 % of cases positive for late onset PE after inclusion of all parameters mentioned above with PlGF testing. Hence, PlGF test had the maximum detection rate for early onset PE. However, the predictive efficacy for detection of PE and fetal growth restriction (FGR) is quite good when PAPP-A is combined along with first trimester risk prediction using maternal characteristics, MAP, and uterine artery PI. The adverse outcomes were very minimal in the screen negative group, thus first trimester screening for PE and FGR definitely helps in triaging patients earlier in pregnancy giving the advantage of adding low-dose aspirin and increasing surveillance in screen positive group which would help us in minimizing adverse perinatal outcomes.