scholarly journals First-Trimester Uterine Artery Doppler for the Prediction of Preeclampsia in Nulliparous Women: The Great Obstetrical Syndrome Study

2018 ◽  
Vol 36 (09) ◽  
pp. 930-935
Author(s):  
Suzanne Demers ◽  
Amélie Boutin ◽  
Cédric Gasse ◽  
Olivier Drouin ◽  
Mario Girard ◽  
...  
Keyword(s):  
Gestational Age ◽  
Uterine Artery ◽  
Prediction Models ◽  
False Positive Rate ◽  
First Trimester ◽  
Maternal Characteristics ◽  
Receiver Operating Characteristic Curves ◽  
Nulliparous Women ◽  
Positive Rate

Objective This study aimed to estimate the performance of first-trimester uterine artery (UtA) pulsatility index (PI) for the prediction of preeclampsia (PE). Study Design We conducted a prospective cohort study of nulliparous women with singleton gestation at 11 to 13 6/7 weeks. UtA-Doppler's was performed on both UtAs and the mean UtA-PI was reported in multiple of median (MoM) adjusted for gestational age. Using receiver operating characteristic curves and their area under the curves (AUC); we calculated the performance of UtA-PI for the prediction of PE. Proportional hazard models were used to develop prediction models combining UtA-PI and maternal characteristics. Results Out of 4,676 participants with completed follow-up, 232 (4.9%) developed PE, including 202 (4.3%) term and 30 (0.6%) preterm PE. Mean UtA-PI decreased with gestational age between 11 and 13 6/7 weeks (p < 0.001). First-trimester UtA-PI was associated with preterm (AUC: 0.69; 95% CI [confidence interval]: 0.57–0.80) but not with term (AUC: 0.52; 95% CI: 0.48–0.56) PE. UtA-PI combined with maternal characteristics could predict 45% of preterm PE at a false positive rate of 10%. Conclusion First-trimester UtA-PI decreases with gestational age between 11 and 13 6/7 weeks and is associated with the risk of preterm but not term PE.

Taiwanese new direction in prediction of early pregnancy preeclampsia: a prospective and non-interventional study

2020 ◽  
Author(s):  
Yen-Tin Chen ◽  
Tzu-Yi Lin ◽  
Po-Jen Cheng ◽  
Kok-Seong Chan ◽  
Hui-Yu Huang ◽  
...  
Keyword(s):  
False Positive Rate ◽  
Model Performance ◽  
First Trimester ◽  
Patient Specific ◽  
Interventional Study ◽  
High Detection Rate ◽  
Maternal Characteristics ◽  
Positive Rate ◽  
Trimester Screening ◽  
Set Up

Abstract Background First trimester screening is essential to preeclampsia (PE) prevention. Fetal Medicine Foundation (FMF) model combined maternal characteristics with mean arterial pressure (MAP), uterine artery pulsatility index (UtAPI) and placental growth factor (PlGF) to estimate risk. High detection rate (DR) was observed in Asia. The study aims to evaluate performance of screening in Taiwan.Methods This was a prospective and non-interventional study between January, 2017 and June, 2018. Data was collected from 700 pregnant women at 11+ 0-13+ 6 gestational week. Maternal characteristics were recorded. MAP, UtAPI and PlGF were measured and converted into Multiple of the Median (MoM). Patient-specific risks were calculated with FMF model. Performance of screening was examined by ROC curve and DR.Results 25 women (3.57%) contracted PE, including 8 with preterm PE (1.14%). In preterm PE, mean MoM of MAP and UtAPI were higher (1.096 vs 1.000; 1.084 vs 1.035). Mean MoM of PlGF was lower (0.927 vs 1.031). DR in preterm PE achieved 12.5%, 50.0%, 50.0% and 62.5% at false-positive rate (FPR) of 5%, 10%, 15% and 20%.Conclusion FMF model showed high DR for PE in Taiwan. Integration of PE and Down screening could set up a one-step workflow.

Predictive values of clinical parameters and biophysical and biochemical markers in the first trimester for the detection of small-for-gestational age fetuses

2021 ◽  
Vol 49 (1) ◽  
pp. 73-79
Author(s):  
Irene Reali Antunes ◽  
Guilherme Antonio Rago Lobo ◽  
Edward Araujo Júnior ◽  
David Baptista da Silva Pares
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Biochemical Markers ◽  
Biochemical Parameters ◽  
Uterine Artery ◽  
First Trimester ◽  
Predictive Values ◽  
Maternal Characteristics ◽  
Group Iii ◽  
Group Ii

AbstractObjectivesTo evaluate the predictive values of maternal characteristics, biophysical parameters (mean arterial pressure [MAP] and Doppler uterine artery measurements), and biochemical parameters (pregnancy-associated plasma protein A [PAPP-A] and placental growth factor [PlGF]) alone and in association for small-for-gestational age (SGA) fetuses.MethodsWe performed a retrospective analysis of a prospective observational study that evaluated 615 pregnant women in the first trimester using ultrasonography. For all the women, information regarding clinical and obstetric histories, MAP, and uterine artery mean pulsatility index (UtA-PI), and blood samples for analysis of biochemical markers (PAPP-A and PlGF) were obtained. The patients were grouped according to birth weight as follows: group I (n=571), >10th percentile (control); group II (n=44), <10th percentile; and group III (n=34), <5th percentile. The predictive values of the variables for the detection of SGA fetuses were calculated using a logistic regression model and an analysis of the area under the receiver-operating characteristic curve (AUC).ResultsThe sensitivity rates of the maternal characteristics, biophysical markers (MAP and UtA-PI), biochemical markers (PAPP-A and PlGF), and the association between them were: 23.3, 32.5, 25, and 30% respectively, at a false-positive (FP) rate of 10%, in group II and 26.5, 26.5, 23.5, and 23.5%, respectively, at a FP rate of 10% in group III.ConclusionsThe predictive performances of the combination of maternal characteristics and biophysical and biochemical parameters were unsatisfactory, with a slight improvement in the predictive capacity for SGA fetuses <10th percentile.

Simple approach based on maternal characteristics and mean arterial pressure for the prediction of preeclampsia in the first trimester of pregnancy

2017 ◽  
Vol 45 (7) ◽  
Author(s):  
Rebeca Silveira Rocha ◽  
Júlio Augusto Gurgel Alves ◽  
Sammya Bezerra Maia e Holanda Moura ◽  
Edward Araujo Júnior ◽  
Alberto Borges Peixoto ◽  
...  
Keyword(s):  
Predictive Value ◽  
Skin Color ◽  
Characteristic Curve ◽  
False Positive Rate ◽  
First Trimester ◽  
Maternal Characteristics ◽  
Arterial Blood ◽  
Positive Rate ◽  
History Of ◽  
First Trimester Of Pregnancy

AbstractAim:To propose a simple model for predicting preeclampsia (PE) in the 1Methods:A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1Results:We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) of 0.79 [95% confidence interval (CI)=0.76–0.82]. For preterm PE, the best model was MC+MAP, with an AUC ROC of 0.84 (95% CI=0.81–0.87). For term PE, the best model was MC, with an AUC ROC of 0.75 (0.72–0.79). The MC+MAP model demonstrated a detection rate of 67% cases of preterm PE, with a false-positive rate of 10%, positive predictive value of 17% and negative predictive value of 99%.Conclusion:The MC+MAP model showed good accuracy in predicting preterm PE in the 1

Improving diagnosis of acute appendicitis with atypical findings by Tc-99m HMPAO leukocyte scan

2002 ◽  
Vol 41 (01) ◽  
pp. 37-41 ◽  
Author(s):  
S. Shung-Shung ◽  
S. Yu-Chien ◽  
Y. Mei-Due ◽  
W. Hwei-Chung ◽  
A. Kao
Keyword(s):  
Acute Appendicitis ◽  
False Positive ◽  
False Positive Rate ◽  
Accurate Method ◽  
Clinical Findings ◽  
Pathological Findings ◽  
Lower Quadrant ◽  
Predictive Values ◽  
Positive Rate

Summary Aim: Even with careful observation, the overall false-positive rate of laparotomy remains 10-15% when acute appendicitis was suspected. Therefore, the clinical efficacy of Tc-99m HMPAO labeled leukocyte (TC-WBC) scan for the diagnosis of acute appendicitis in patients presenting with atypical clinical findings is assessed. Patients and Methods: Eighty patients presenting with acute abdominal pain and possible acute appendicitis but atypical findings were included in this study. After intravenous injection of TC-WBC, serial anterior abdominal/pelvic images at 30, 60, 120 and 240 min with 800k counts were obtained with a gamma camera. Any abnormal localization of radioactivity in the right lower quadrant of the abdomen, equal to or greater than bone marrow activity, was considered as a positive scan. Results: 36 out of 49 patients showing positive TC-WBC scans received appendectomy. They all proved to have positive pathological findings. Five positive TC-WBC were not related to acute appendicitis, because of other pathological lesions. Eight patients were not operated and clinical follow-up after one month revealed no acute abdominal condition. Three of 31 patients with negative TC-WBC scans received appendectomy. They also presented positive pathological findings. The remaining 28 patients did not receive operations and revealed no evidence of appendicitis after at least one month of follow-up. The overall sensitivity, specificity, accuracy, positive and negative predictive values for TC-WBC scan to diagnose acute appendicitis were 92, 78, 86, 82, and 90%, respectively. Conclusion: TC-WBC scan provides a rapid and highly accurate method for the diagnosis of acute appendicitis in patients with equivocal clinical examination. It proved useful in reducing the false-positive rate of laparotomy and shortens the time necessary for clinical observation.

scholarly journals Role of Invasive Urodynamic Studies in Establishing Cauda Equina Syndrome and Postoperative Recovery

2020 ◽  
pp. 219256822097964
Author(s):  
Abhinandan Reddy Mallepally ◽  
Bibhudendu Mohapatra ◽  
Kalidutta Das
Keyword(s):  
Clinical Symptoms ◽  
False Positive Rate ◽  
Cauda Equina ◽  
Postoperative Recovery ◽  
Normal Bladder ◽  
Acontractile Detrusor ◽  
Positive Rate ◽  
Acute Radiculopathy ◽  
Operative Recovery

Study design: Retrospective with prospective follow-up. Objective: Confirming the diagnosis of CES based purely on symptoms and signs is unreliable and usually associated with high false positive rate. A missed diagnosis can permanently disable the patient. Present study aims to determine the relationship between clinical symptoms/ signs (bladder dysfunction) with UDS, subsequently aid in surgical decision making and assessing post-operative recovery. Methods: A prospective follow-up of patients with disc herniation and bladder symptoms from January 2018 to July 2020 was done. All patients underwent UDS and grouped into acontractile, hypocontractile and normal bladder. Data regarding PAS, VAC, GTP, timing to surgery and onset of radiculopathy and recovery with correlation to UDS was done preoperatively and post operatively. Results: 107 patients were studied (M-63/F-44). Patients with PAS present still had acontractile (61%) or hypocontractile (39%) detrusor and with VAC present, 57% had acontractile and 43% hypocontractile detrusors. 10 patients with both PAS and VAC present had acontractile detrusor. 82% patients with acute radiculopathy (<2 days) improved when operated <24 hrs while only 47% showed improvement with chronic radiculopathy. The detrusor function recovered in 66.1% when operated <12 hours, 40% in <12-24 hours of presentation. Conclusion: Adjuvant information from UDS in combination with clinicoradiological findings help in accurate diagnosis even in patients with no objective motor and sensory deficits. Quantitative findings on UDS are consistent with postoperative recovery of patient’s urination power, representing improvement and can be used as a prognostic factor.

Considerations on the region of interest in the ROC space

2021 ◽  
pp. 096228022110605
Author(s):  
Luigi Lavazza ◽  
Sandro Morasca
Keyword(s):  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Region Of Interest ◽  
True Positive Rate ◽  
True Positive ◽  
Receiver Operating Characteristic Curves ◽  
Positive Rate ◽  
Receiver Operating

Receiver Operating Characteristic curves have been widely used to represent the performance of diagnostic tests. The corresponding area under the curve, widely used to evaluate their performance quantitatively, has been criticized in several respects. Several proposals have been introduced to improve area under the curve by taking into account only specific regions of the Receiver Operating Characteristic space, that is, the plane to which Receiver Operating Characteristic curves belong. For instance, a region of interest can be delimited by setting specific thresholds for the true positive rate or the false positive rate. Different ways of setting the borders of the region of interest may result in completely different, even opposing, evaluations. In this paper, we present a method to define a region of interest in a rigorous and objective way, and compute a partial area under the curve that can be used to evaluate the performance of diagnostic tests. The method was originally conceived in the Software Engineering domain to evaluate the performance of methods that estimate the defectiveness of software modules. We compare this method with previous proposals. Our method allows the definition of regions of interest by setting acceptability thresholds on any kind of performance metric, and not just false positive rate and true positive rate: for instance, the region of interest can be determined by imposing that [Formula: see text] (also known as the Matthews Correlation Coefficient) is above a given threshold. We also show how to delimit the region of interest corresponding to acceptable costs, whenever the individual cost of false positives and false negatives is known. Finally, we demonstrate the effectiveness of the method by applying it to the Wisconsin Breast Cancer Data. We provide Python and R packages supporting the presented method.

scholarly journals Clinical and Economic Evaluation after Adopting Contingent Cell-Free DNA Screening for Fetal Trisomies in South Spain

2020 ◽  
Vol 47 (10) ◽  
pp. 749-756
Author(s):  
José A. Sainz ◽  
María R. Torres ◽  
Ignacio Peral ◽  
Reyes Granell ◽  
Manuel Vargas ◽  
...  
Keyword(s):  
False Positive Rate ◽  
Cost Effective ◽  
First Trimester ◽  
Nuchal Translucency ◽  
University Hospitals ◽  
Combined Test ◽  
Positive Rate ◽  
Fetal Malformations ◽  
Cfdna Screening ◽  
Singleton Pregnancies

<b><i>Introduction:</i></b> Contingent cell-free (cf) DNA screening on the basis of the first-trimester combined test (FCT) results has emerged as a cost-effective strategy for screening of trisomy 21 (T21). <b><i>Objectives:</i></b> To assess performance, patients’ uptake, and cost of contingent cfDNA screening and to compare them with those of the established FCT. <b><i>Methods:</i></b> This is a prospective cohort study including all singleton pregnancies attending to their FCT for screening of T21 at 2 university hospitals in South Spain. When the FCT risk was ≥1:50, there were major fetal malformations, or the nuchal translucency was ≥3.5 mm, women were recommended invasive testing (IT); if the risk was between 1:50 and 1:270, women were recommended cfDNA testing; and for risks bellow 1:270, no further testing was recommended. Detection rate (DR), false-positive rate (FPR), patients’ uptake, and associated costs were evaluated. <b><i>Results:</i></b> We analyzed 10,541 women, including 46 T21 cases. DR of our contingent strategy was 89.1% (41/46) at 1.4% (146/10,541) FPR. Uptake of cfDNA testing was 91.2% (340/373), and overall IT rate was 2.0%. The total cost of our strategy was €1,462,895.7, similar to €1,446,525.7 had cfDNA testing not been available. <b><i>Conclusions:</i></b> Contingent cfDNA screening shows high DR, low IT rate, and high uptake at a similar cost than traditional screening.

Impact of Including or Removing Nuchal Translucency Measurement on the Detection and False-Positive Rates of First-Trimester Down Syndrome Screening

2015 ◽  
Vol 40 (3) ◽  
pp. 214-218 ◽  
Author(s):  
Emmanuel Spaggiari ◽  
Isabelle Czerkiewicz ◽  
Corinne Sault ◽  
Sophie Dreux ◽  
Armelle Galland ◽  
...  
Keyword(s):  
Down Syndrome ◽  
False Positive ◽  
False Positive Rate ◽  
Method Comparison ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Routine Practice ◽  
Detection Rates ◽  
Significant Difference ◽  
Positive Rate

Introduction: First-trimester Down syndrome (DS) screening combining maternal age, serum markers (pregnancy-associated plasma protein-A and beta-human chorionic gonadotropin) and nuchal translucency (NT) gives an 85% detection rate for a 5% false-positive rate. These results largely depend on quality assessment of biochemical markers and of NT. In routine practice, despite an ultrasound quality control organization, NT images can be considered inadequate. The aim of the study was to evaluate the consequences for risk calculation when NT measurement is not taken into account. Material and Method: Comparison of detection and false-positive rates of first-trimester DS screening (PerkinElmer, Turku, Finland), with and without NT, based on a retrospective study of 117,126 patients including 274 trisomy 21-affected fetuses. NT was measured by more than 3,000 certified sonographers. Results: There was no significant difference in detection rates between the two strategies including or excluding NT measurement (86.7 vs. 81.8%). However, there was a significant difference in the false-positive rates (2.23 vs. 9.97%, p < 0.001). Discussion: Sonographers should be aware that removing NT from combined first-trimester screening would result in a 5-fold increase in false-positive rate to maintain the expected detection rates. This should be an incentive for maintaining quality in NT measurement.

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