Integrating Combined First Trimester Screening for Preeclampsia into Routine Ultrasound Examination

Abstract

Introduction The Fetal Medicine Foundation (FMF) London has developed a first trimester screening algorithm for preeclampsia (PE), based on maternal characteristics and past risk factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and placental growth factor (PlGF). The aim of this study was to determine the feasibility of integrating PE screening into routine practice.

Material and Methods All pregnancies with a fetal crown-rump length of 45 – 84 mm presenting to our ultrasound department between January 2014 and September 2020 were included in this analysis. Screening for PE was offered to singleton pregnancies only. The number of screening tests performed in the eligible population was assessed and the reasons for missed screenings identified with the help of the electronic clinical database. SPSS Statistics 25 and GraphPad version 8.0 for Windows were used for statistical analysis.

Results 6535 pregnancies were included, 4510 (69.0%) of which were screened for PE. The percentage of patients being offered PE screening increased over the years from 63.1 to 96.7% (r_s = 0.96; p = 0.003), while the rate of screenings performed in eligible patients remained stable at a median [range] of 86.2% [78.0 – 91.8%] (p = ns). 2025 (31.0%) pregnancies were not screened for PE, 1306 (64.5%) because they were not eligible for screening. 145 (2.2%) women explicitly declined PE screening; their background risk was lower than that of women who accepted screening.

Conclusion Our study shows that integration of PE screening into the routine first trimester ultrasound scan is feasible and widely accepted by pregnant women and health care providers.

Zusammenfassung

Einleitung Die Fetal Medicine-Stiftung (FMF) in London hat einen Algorithmus für ein Ersttrimester-Screening auf Präeklampsie (PE) entwickelt, das auf maternalen Merkmalen und Risikofaktoren in der Anamnese, dem mittleren arteriellen Druck (MAP), dem Pulsatilitätsindex der A. uterina (UtA-PI) sowie dem plazentaren Wachstumsfaktor (PlGF) basiert. Ziel dieser Studie war es, die Machbarkeit einer Integration von PE-Screening in die klinische Praxis zu ermitteln.

Material und Methoden Alle Schwangerschaften mit einer fetalen Scheitel-Steiß-Länge von 45 bis 84 mm, die sich zwischen Januar 2014 und September 2020 in der Ultraschallabteilung vorstellten, wurden in dieser Analyse aufgenommen. Ein PE-Screening wurde nur Frauen mit Einlingsschwangerschaften angeboten. Die Anzahl der in der teilnahmeberechtigten Population durchgeführten Screeningtests wurde evaluiert, und die Gründe für nicht erfolgte Untersuchungen wurden mithilfe der elektronischen Datenbank der Klinik identifiziert. SPSS Statistics 25 und GraphPad Version 8.0 für Windows wurden für die statistische Analyse verwendet.

Ergebnisse Insgesamt wurden 6535 Schwangerschaften in die Studie aufgenommen, davon wurden 4510 (69,0%) auf das Risiko einer Präeklampsie getestet. Der Prozentsatz von Patientinnen, denen PE-Screening angeboten wurde, nahm über die Jahre von 63,1 auf 96,7% zu (r_s = 0,96; p = 0,003), wohingegen der Prozentsatz der Untersuchungen, die bei infrage kommenden Patientinnen durchgeführt wurde, bei einem Mittelwert [Bandbreite] von 86,2% [78,0 – 91,8%] (p = ns) stabil blieb. 2025 (31,0%) Schwangerschaften wurden nicht auf das PE-Risiko untersucht, davon 1306 (64,5%), weil sie die Kriterien für ein Screening nicht erfüllten. 145 (2,2%) Frauen lehnten ein PE-Screening explizit ab; ihr Hintergrundrisiko war niedriger als das Risko bei den Frauen, die ein PE-Screening angenommen haben.

Schlussfolgerung Unsere Studie zeigt, dass die Integration von PE-Screening in routinemäßig durchgeführten Ersttrimester-Ultraschalluntersuchungen machbar ist, und dass sie von Schwangeren und Gesundheitsdienstleistern weithin akzeptiert wird.

Key words

obstetrics - sonography - pregnancy - preeclampsia - epidemiology

Schlüsselwörter

Geburtshilfe - Ultraschall - Schwangerschaft - Präeklampsie - Epidemiologie

Publikationsverlauf

Eingereicht: 07. März 2021

Angenommen nach Revision: 22. Juni 2021

Artikel online veröffentlicht:
03. März 2022

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