Predikcia preeklampsie v prvom trimestri – pilotná štúdia
Authors:
M. Dugátová 1; J. Luha 2; E. Korňanová 1; M. Borovský 1
Authors‘ workplace:
First Department of Gynecology and Obstetrics, Comenius University and University Hospital, Bratislava, Slovakia
1; Institute of Medical Biology, Genetics and Clinical Genetics, School of Medicine, Comenius University, Bratislava, Slovakia
2
Published in:
Ceska Gynekol 2019; 84(4): 276-282
Category:
Overview
Cieľ štúdie: Cieľom štúdie bolo zhodnotiť možnosti predikcie preeklampsie v prvom trimestri v rizikových graviditách.
Typ štúdie: Prospektívna štúdia.
Názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika Lekárskej fakulty Univerzity Komenského, Univerzitná nemocnica v Bratislave.
Metodika: Štúdia zahŕňala 77 žien, ktoré boli vyšetrené v prvom trimestri medzi 11+0 a 13+6 gestačným týždňom od 1. 6. 2016 do 1. 6. 2017. Pacientky porodili do 31. 2. 2018. Štúdia bola schválená etickou komisiou a všetky pacientky podpísali informovaný súhlas. Do štúdie sme zahrnuli pacientky, ktoré mali minimálne jeden rizikový faktor pre vznik preeklampsie. Bolo realizované ultrazvukové vyšetrenie v prvom trimestri, zmerali sme pulzatívny index uterinnej artérie a tlak. Údaje o PAPP-A proteíne sme získali zo skríningového krvného testu. Tieto parametre boli použité na predikciu preeklampsie. Potom sme vyrátali senzitivitu a špecificitu. Preeklampsiu sme hodnotili podľa diagnostických kritérií American College Obstetricians and Gynecologists z roku 2013. V poslednej časti sme porovnali perinatálne výsledky u pacientok s preeklampsiou a kontrolnou skupinou. Štatistická analýza bola realizovaná IBM SPSS Statistics 25 Software. Rizikové faktory sme vyhodnotili pomocou Fisherovho exaktného testu a odds ratio. Mannov-Whitneyov test a one way analysis of variance boli použité na zistenie signifikantnosti prediktorov.
Výsledky: Pacientky, ktoré otehotneli po asistovanej reprodukcii, mali signifikantne vyššiu pravdepodobnosť vzniku preeklampsie (odds ratio = 7,7; p = 0,028). Takisto pacientky s viacplodovým tehotenstvom mali vyššie riziko vzniku preeklampsie (odds ratio = 16,5; p = 0,031). Len stredný arteriálny tlak sa potvrdil ako signifikantný prediktor preeklampsie v 12. gestačnom týždni.
Záver: Stredný arteriálny tlak je jednoduchý a nízkonákladový prediktor, ktorý má ale nízku senzitivitu 66,6 % a špecificitu 49 %.
Klíčová slova:
preeklampsia – pregnancy-associated plasma (PAPP-A) proteín – stredný arteriálny tlak – dopplerovské vyšetrenie uterinných artérií – rizikové faktory – pulzatívny index
Sources
1. American College of Obstetricians and Gynecologists. Hypertension Pregnancy – induced. Practice bulletin, 2013, 2, WQ 244.
2. Gomes, SM., Carlos-Alves, M., Trocado, V., et al. Prediction of adverse pregnancy outcomes by extreme values of first trimester screening markers. Obstet Med, 2017, 10(3), p. 132–137. doi: 10.1177/1753495X17704799.
3. Hlaváčik, M. Význam ultrazvukového vyšetrenia pri preeklampsii. Gynekol prax, 2017, 15(3), s. 148–151.
4. Jiang, M., Lash, EG., Zhao, X., et al. CircRNA-0004904, CircRNA-0001855, and PAPP-A: Potential novel biomarkers for the prediction of pre-eclampsia. Cell Physiol Biochem, 2018, 46, p. 2576–2586. doi: 10.1159/000489685.
5. Korbeľ, M., Nižňanská, Z., Havalda, A., et al. Preeklampsia – incidencia v Slovenskej republike v rokoch 1997–2016. Gynekol prax, 2017, 15(3), s.133–136.
6. Litwińska, E., Litwińska, M., Oszukowski, P., et al. Combined screening for early and late pre-eclampsia and intrauterine growth restriction by maternal history, uterine artery Doppler, mean arterial pressure and biochemical markers. Adv Clin Exp Med, 2017, 26(3), p. 439–448. doi: 10.17219/acem/62214.
7. Livrinova, V., Petrov, I., Samardziski, I., et. al. obstetric outcome in pregnant patients with low level of pregnancy-associated plasma protein a in first trimester. Open Access Macedonian J Med Sci, 2018, 6(6), p. 1028–1031. https://doi.org/10.3889/oamjms.2018.238.
8. Luewan, S., Teja-intr, M., Sirichotiyakul, S., et al. Low maternal serum pregnancy-associated plasma protein-A as a risk factor of pre-eclampsia. Singapore Med J, 2018, 59(1), p. 55–59. https://doi.org/10.11622/smedj.2017034.
9. Murtoniemi, K., Villa, MP., Matomäk, J., et al. Prediction of pre-eclampsia and its subtypes in high-risk cohort: hyperglycosylated human chorionic gonadotropin in multivariate models. BMC Pregnancy Childbirth, 2018, 18, p. 279. https://doi.org/10.1186/s12884-018-1908-9.
10. Orabona, R., Sciatti, E., Vizzardi, E., et al. Endothelial dysfunction and vascular stiffness in women with previous pregnancy complicated by early or late pre-eclampsia. Ultrasound Obstet Gynecol, 2017, 49, p. 116–123. doi:10.1002/uog.15893.
11. Oťapková, P., Záhumenský, J. Neskorá preeklampsia. Slov Gynek Pôrod, 2017, 24, s. 114–117.
12. Parra-Cordero, M., Rodrigo, R., Barja, P., et al. Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during first trimester of pregnancy. Ultrasound Obstet Gynecol, 2013, 41, p. 538–544. doi:10.1002/uog.12264.
13. Pipkin, F., Phil, D. Risk factors for pre-eclampsia. N Engl J Med, 2001, 344, p. 925–926. doi: 10.1056/NEJM200103223441209.
14. Reismullerova, L., Holoman, K., Polackova-Borosova, M., et al. Polycystic ovary syndrome – a risk factor of pre-eclampsia after in vitro fertilisation. Bratisl Lek Listy, 2015, 116(5), s. 311–315. doi: 10.4149/BLL_2015_058.
15. Stepan, H., Hund, M., Gencay, M., et al. A comparison of the diagnostic utility of the sFlt-1/PlGF ratio versus PlGF alone for the detection of pre-eclampsia/HELLP syndrome. Hypertens Pregnancy, 2016, 35(3), p. 295–305. http://dx.doi.org/10.3109/10641955.2016.1141214.
16. Subki, HA., Algethami, RM., Baabdullah, MW., et al. Prevalence, risk factors, and fetal and maternal outcomes of hypertensive disorders of pregnancy: A retrospective study in Western Saudi Arabia. Oman Med J, 2018, 33(5), p. 409–415. doi 10.5001/omj.2018.75.
17. Sung, UK., Roh, AJ., Eoh, JK., et al. Maternal serum placental growth factor and pregnancy-associated plasma protein A measured in the first trimester as parameters of subsequent pre-eclampsia and small-for-gestational-age infants: A prospective observational study. Obstet Gynecol Sci, 2017, 60(2), p. 154–162. https://doi.org/10.5468/ogs.2017.60.2.154.
18. Tan, YM., Koutoulas, L., Wright, KHD., et al. Protocol for the prospective validation study: ‚Screening programme for pre-eclampsia‘ (SPREE). Ultrasound Obstet Gynecol, 2017, 50, p. 175–179. doi:10.1002/uog.17467.
19. Tan, YM., Wright, D., Syngelaki, A., et al. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: results of SPREE. Ultrasound Obstet Gynecol, 2018, 51, p. 743–750. doi: 10.1002/uog.19039. Epub 2018 Mar 14.
20. Thomopoulos, C., Salamalekis, G., Kintis, K., et al. Risk of hypertensive disorders in pregnancy following assisted reproductive technology: overview and meta-analysis. J Clin Hypertens (Greenwich), 2017, 19(2), p. 173–183. doi: 10.1111/jch.12945.
21. Tserensambuu, U., et al. The use of biochemical and biophysical markers in early screening for pre-eclampsia in Mongolia. Med Sci, 2018, 6, p. 57. doi: 10.3390/medsci6030057.
22 Yu, N., Cui, H., Chen, X., et al. First trimester maternal serum analytes and second trimester uterine artery Dopple r in the prediction of pre-eclampsia and fetal growth restriction. Taiwan J Obstet Gynecol, 2017, 56(3), p. 358–361. PMID: 28600048.
23. Zhu, L., Zhang, Y., Liu, Y., et al. Maternal and live-birth outcomes of pregnancies following assisted reproductive technology: A retrospective cohort study. Sci Reports, 2016, 6, p. 35141. doI: 10.1038/srep35141.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
2019 Issue 4
Most read in this issue
- Diagnosis of endometriosis 3rd part – Ultrasound diagnosis of deep endometriosis
- Diagnosis of endometriosis 2nd part – Ultrasound diagnosis of endometriosis (adenomyosis, endometriomas, adhesions) in the community
- Diagnosis of endometriosis 1st part – Overview of diagnostic approaches
- Distální vaginální ageneze