Second Trimester Screening of Preeclampsia Using Maternal Characteristics and Uterine and Ophthalmic Artery Doppler

2016 ◽  
Vol 39 (02) ◽  
pp. 190-197 ◽  
Author(s):  
Paulo Praciano de Souza ◽  
Júlio Gurgel Alves ◽  
Sammya Bezerra Maia e Holanda Moura ◽  
Edward Araujo Júnior ◽  
Wellington Martins ◽  
...  
Keyword(s):  
Pregnant Women ◽  
False Positive ◽  
Ophthalmic Artery ◽  
False Positive Rate ◽  
Categorical Variables ◽  
Second Trimester ◽  
Maternal Characteristics ◽  
Maternal Risk ◽  
Second Trimester Screening ◽  
Positive Rate

Abstract Purpose To establish the performance of a multi-parametric test including maternal risk factors and maternal uterine and ophthalmic artery Doppler in the second trimester of pregnancy for the prediction of preeclampsia (PE). Materials and Methods We performed a prospective observational cohort study with pregnant women who underwent a second trimester morphology scan. Maternal uterine and ophthalmic artery Doppler examinations were performed in 415 singleton pregnancies between 18 and 23 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to the time of discharge post-delivery. The control and PE groups were compared to continuous variables using the Kruskal-Wallis test and to categorical variables using the Chi-square and Fisher exact tests. Univariate and multivariate logistic regression analyses were performed to determine the best model for the prediction of PE. Results 40 (9.6 %) pregnant women developed PE. We observed significant differences in the body mass index (BMI) (p < 0.001), parity (p < 0.001), mean arterial pressure (MAP) (p < 0.001), and pulsatility index (PI) of uterine artery Doppler (p < 0.001) between PE and control groups. The best model for the prediction of PE included maternal characteristics, MAP, maternal uterine and ophthalmic artery Doppler with area under receiver operating characteristics (ROC) curve of 0.710 (95 % confidence interval, 613 – 0.807) with a sensitivity of 45 % to a false-positive rate of 10 % and 35 % to a false-positive rate of 5 %. Conclusion Maternal ophthalmic artery Doppler did not promote a significant increase in the PE detection rate during the second trimester scan.

scholarly journals Antenatal screening for aneuploidy

2017 ◽  
Vol 7 (1) ◽  
pp. 234 ◽  
Author(s):  
Smita S. Patne ◽  
Aditi J. Upadhye ◽  
Shantanu C. Shembekar ◽  
Chaitanya A. Shembekar ◽  
Jayshree J. Upadhye
Keyword(s):  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
False Positive ◽  
False Positive Rate ◽  
First Trimester ◽  
Second Trimester ◽  
Marker Test ◽  
Second Trimester Screening ◽  
Positive Rate ◽  
Trimester Screening

Background: It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome and other aneuploides, whether to perform first-trimester screening or to perform second-trimester screening or both.Methods: Women with singleton and multiple pregnancies underwent first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin at 10 weeks 3 days through 13 weeks 6 days of gestation). Also, second-trimester quadruple screening (measurement of alpha-fetoprotein, total human chorionic gonadotropin, unconjugated estriol, and inhibin A) and triple marker test was done from 15 to 18 weeks of gestation.Results: 12 (5%) patients had positive screening test for combined screening in first trimester, 6 (10.9%) patients had positive screening for quadruple test while 1 (2.85%) patients had positive screening for triple test. Out of 19 positive screening, 16 (84.21%) had their amniocentesis done for confirmation of diagnosis. In all 16 patients, chromosomal analysis was normal. Not a single patient turned out to have a baby with Down syndrome or any other aneuploidy. False positive rate for combined screening in first trimester was 5%, false positive rate for quadruple test in second trimester was 10.9%, false positive rate for triple marker test in second trimester was 2.85%.Conclusions: First-trimester combined screening is better than second-trimester quadruple test or triple marker test for syndrome or any other aneuploidy.

scholarly journals Hyperglycosylated Human Chorionic Gonadotropin (Invasive Trophoblast Antigen) Immunoassay: A New Basis for Gestational Down Syndrome Screening

1999 ◽  
Vol 45 (12) ◽  
pp. 2109-2119 ◽  
Author(s):  
Laurence A Cole ◽  
Shohreh Shahabi ◽  
Utku A Oz ◽  
Ray O Bahado-Singh ◽  
Maurice J Mahoney
Keyword(s):  
Down Syndrome ◽  
False Positive ◽  
False Positive Rate ◽  
Normal Karyotype ◽  
Screen Test ◽  
Β Subunit ◽  
Second Trimester ◽  
Marker Test ◽  
Positive Rate ◽  
Down Syndrome Screening

Abstract Background: Serum human chorionic gonadotropin (hCG) and hCG free β-subunit tests are used in combination with unconjugated estriol and α-fetoprotein in the triple screen test, and with the addition of inhibin-A in the quadruple marker test for detecting Down syndrome in the second trimester of pregnancy. These tests have a limited detection rate for Down syndrome: ∼40% for hCG or free β-subunit alone, ∼60% for the triple screen test, and ∼70% for the quadruple marker test, all at 5%, or a relatively high, false-positive rate. New tests are needed with higher detection and lower false rates. Hyperglycosylated hCG (also known as invasive trophoblast antigen or ITA) is a new test. It specifically detects a unique oligosaccharide variant of hCG associated with Down syndrome pregnancies. We evaluated this new Down syndrome-directed test in prenatal diagnosis. Methods: Hyperglycosylated hCG was measured in urine samples from women undergoing amniocentesis for advanced maternal age concerns at 14–22 weeks of gestation, 1448 with normal karyotype and 39 with Down syndrome fetuses. Results: The median hyperglycosylated hCG value was 9.5-fold higher in Down syndrome cases (9.5 multiples of the normal karyotype median). The single test detected 80% of Down syndrome cases at a 5% false-positive rate. Urine hyperglycosylated hCG was combined with urine β-core fragment (urine breakdown product of serum hCG free β-subunit), serum α-fetoprotein, and maternal age-related risk. This urine-serum combination detected 96% of Down syndrome cases at a 5% false-positive rate, 94% of cases at a 3% false-positive rate, and 71% of cases at a 1% false-positive rate. These detection rates exceed those of any previously reported combination of biochemical markers. Conclusions: Hyperglycosylated hCG is a new base marker for Down syndrome screening in the second trimester of pregnancy. The measurement of hyperglycosylated hCG can fundamentally improve the performance of Down syndrome screening protocols.

scholarly journals Predicting first-trimester outcome of embryos with cardiac activity in women with recurrent spontaneous abortion

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052091182
Author(s):  
Huixian Li ◽  
Shuang Qin ◽  
Fanfan Xiao ◽  
Yuhong Li ◽  
Yunhe Gao ◽  
...  
Keyword(s):  
Pregnant Women ◽  
False Positive ◽  
Detection Rate ◽  
False Positive Rate ◽  
Cardiac Activity ◽  
First Trimester ◽  
Clinical Indicators ◽  
Early Outcome ◽  
Heart Motion ◽  
Positive Rate

Objective This study was performed to evaluate the capability of routine clinical indicators to predict the early outcome of embryos with cardiac activity in women with recurrent spontaneous abortion (RSA). Methods A retrospective cohort study of pregnant women with a history of RSA in a Chinese tertiary hospital was performed using unadjusted and multivariable logistic regression. Results Of 789 pregnant women with RSA, 625 (79.21%) had ongoing pregnancy, whereas 164 (20.79%) developed abortion before 20 full weeks of gestational age even after embryonic heart motion was detected. The final model had an area under the curve of 0.81 (95% confidence interval, 0.78–0.84) with a sensitivity of 74.39%, a specificity of 76.00%, and a false-positive rate of 52.32% at a fixed detection rate of 90%. Conclusions The combination of multiple routine clinical indicators was valuable in predicting the early outcome of embryos with cardiac activity in viable pregnancies with RSA. However, this model might result in a high false-positive rate with a fixed detection rate of 90%; other markers must be investigated to identify first-trimester RSA once positive embryonic heart motion is established.

scholarly journals Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Karina Bilda De Castro Rezende ◽  
Antonio José Ledo Alves Cunha ◽  
Joffre Amim Jr ◽  
Wescule De Moraes Oliveira ◽  
Maria Eduarda Belloti Leão ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Risk Scores ◽  
Cross Sectional ◽  
Fetal Medicine ◽  
Maternal Characteristics ◽  
Positive Rate

BACKGROUND FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. OBJECTIVE This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. METHODS This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. RESULTS A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. CONCLUSIONS We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

scholarly journals SARS-CoV-2 immunochromatographic IgM/IgG rapid test in pregnancy: A false friend?

2020 ◽  
pp. 000456322098049
Author(s):  
M Fabre ◽  
S Ruiz-Martinez ◽  
ME Monserrat Cantera ◽  
A Cortizo Garrido ◽  
Z Beunza Fabra ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Pregnant Women ◽  
Predictive Value ◽  
False Positive ◽  
Screening Tool ◽  
False Positive Rate ◽  
Rapid Test ◽  
Immunochromatographic Assay ◽  
Qualitative Detection ◽  
Positive Rate

Background An increasing body of evidence has revealed that SARS-CoV-2 infection in pregnant women could increase the risk of adverse maternal and fetal outcomes. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted. Therefore, rapid antibody tests have been suggested as an efficient screening tool during pregnancy. Cases We analysed the clinical performance during pregnancy of a rapid, lateral-flow immunochromatographic assay for qualitative detection of SARS-CoV-2 IgG/IgM antibodies. We performed a universal screening including 169 patients during their last trimester of pregnancy. We present a series of 14 patients with positive SARS-CoV-2 immunochromatographic assay rapid test result. Immunochromatographic assay results were always confirmed by chemiluminescent microparticle immunoassays for quantitative detection of SARS-CoV-2 IgG and IgM+IgA antibodies as the gold standard. We observed a positive predictive value of 50% and a false positive rate of 50% in pregnant women, involving a significantly lower diagnostic performance than reported in non-pregnant patients. Discussion Our data suggest that although immunochromatographic assay rapid tests may be a fast and profitable screening tool for SARS-CoV-2 infection, they may have a high false positive rate and low positive predictive value in pregnant women. Therefore, immunochromatographic assay for qualitative detection of SARS-CoV-2 IgG/IgM antibodies must be verified by other test in pregnant patients.

scholarly journals Effectiveness of Alpha-Fetoprotein Variants L2 and L3 as Substitutes of Alpha-Fetoprotein in Screening for Fetal Trisomy 18

2019 ◽  
Author(s):  
Jianxia Huang ◽  
Yiming Chen ◽  
Wensheng Hu
Keyword(s):  
Pregnant Women ◽  
False Positive ◽  
False Positive Rate ◽  
Alpha Fetoprotein ◽  
Trisomy 18 ◽  
Control Group ◽  
Optimal Cutoff ◽  
Marker Combination ◽  
Positive Rate ◽  
Β Hcg

Abstract Purpose To evaluate the effectiveness of alpha-fetoprotein variants (AFP-L2, AFP-L3) for fetal screening of Trisomy 18 in place of alpha fetoprotein (AFP). Methods A case-control study was conducted. The case group included 39 pregnant women diagnosed by karyotype analysis of amniotic fluid cells as bearing Trisomy 18 fetuses. The control group included 48 pregnant women with clinically normal and healthy fetal development. The serum AFP-L2 and AFP-L3 concentrations were detected. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff value, area under the curve (AUC), and assess the screening performance of AFP-L2 and AFP-L3. Results The AFP-L2 and AFP-L3 concentrations in pregnant women with Trisomy 18 fetuses were 7.95±3.57 ng/mL , and 2.53±1.80 ng/mL, respectively, which was significantly higher than those of the control group (3.73±1.63 ng/mL [3.26~4.20], t=6.820, P<0.001, and 0.84±0.60 ng/mL [0.66~1.01], t=5. 588, P<0.001, respectively). The AUC for AFP-L2 and AFP-L3 in screened Trisomy 18 fetuses was 0.848 (95% CI: 0.767-0.930, P < 0.001) and 0.806 (95% CI: 0.707-0.905, P < 0.001), respectively. The optimal cutoff values of AFP-L2 and AFP-L3 for Trisomy 18 fetuses were determined to be 6.340 ng/mL and 1.705 ng/mL, respectively. The corresponding sensitivity, specificity, and Youden index values were 0.615, 1.000, 0.615; 0.6410, 0.958, and 0.599, respectively. Comparisons across multiple modeling methods showed that the highest AUC of screened Trisomy 18 fetuses (0.992 and 0.986) was yielded by AFP-L2 + AFP-L3 + free β-HCG, and AFP-L2 + free β-HCG, with 1.000 sensitivity indicated in both instances. The sensitivities of the four Trisomy 18 screening combinations were all 1.000. In the control group, false positive rates of 22.92%, 8.33%, 12.50%, and 12.50% were observed. The series test showed that the sensitivities of Trisomy 18 screening was 69.23%, 61.54%, 64.10%, and 43.59%, respectively, while a 3.28% false positive rate was found in the control group AFP + free β-HCG marker combination. Conclusion AFP-L2 and AFP-L3 showed high sensitivity and specificity in the screening of fetuses for Trisomy 18. The new indicators did not bring about a significant improvement in screening efficiency but false positive rate was reduced compared to AFP.

scholarly journals Performance of Fetal Medicine Foundation Software for Pre-Eclampsia Prediction Upon Marker Customization: Cross-Sectional Study

10.2196/14738 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e14738 ◽  
Author(s):  
Karina Bilda De Castro Rezende ◽  
Antonio José Ledo Alves Cunha ◽  
Joffre Amim Jr ◽  
Wescule De Moraes Oliveira ◽  
Maria Eduarda Belloti Leão ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Screening Tests ◽  
Risk Scores ◽  
Cross Sectional ◽  
Fetal Medicine ◽  
Maternal Characteristics ◽  
Positive Rate

Background FMF2012 is an algorithm developed by the Fetal Medicine Foundation (FMF) to predict pre-eclampsia on the basis of maternal characteristics combined with biophysical and biochemical markers. Afro-Caribbean ethnicity is the second risk factor, in magnitude, found in populations tested by FMF, which was not confirmed in a Brazilian setting. Objective This study aimed to analyze the performance of pre-eclampsia prediction software by customization of maternal ethnicity. Methods This was a cross-sectional observational study, with secondary evaluation of data from FMF first trimester screening tests of singleton pregnancies. Risk scores were calculated from maternal characteristics and biophysical markers, and they were presented as the risk for early pre-eclampsia (PE34) and preterm pre-eclampsia (PE37). The following steps were followed: (1) identification of women characterized as black ethnicity; (2) calculation of early and preterm pre-eclampsia risk, reclassifying them as white, which generated a new score; (3) comparison of the proportions of women categorized as high risk between the original and new scores; (4) construction of the receiver operator characteristic curve; (5) calculation of the area under the curve, sensitivity, and false positive rate; and (6) comparison of the area under the curve, sensitivity, and false positive rate of the original with the new risk by chi-square test. Results A total of 1531 cases were included in the final sample, with 219 out of 1531 cases (14.30; 95% CI 12.5-16.0) and 182 out of 1531 cases (11.88%; 95% CI 10.3-13.5) classified as high risk for pre-eclampsia development, originally and after recalculating the new risk, respectively. The comparison of FMF2012 predictive model performance between the originally estimated risks and the estimated new risks showed that the difference was not significant for sensitivity and area under the curve, but it was significant for false positive rate. Conclusions We conclude that black ethnicity classification of Brazilian pregnant women by the FMF2012 algorithm increases the false positive rate. Suppressing ethnicity effect did not improve the test sensitivity. By modifying demographic characteristics, it is possible to improve some performance aspects of clinical prediction tests.

scholarly journals First Trimester Genetic Sonogram for Screening Fetal Down Syndrome: a Population-based Study

2020 ◽  
Author(s):  
Kuntharee Traisrisilp ◽  
Supatra Sirichotiyakul ◽  
Fuanglada Tongprasert ◽  
Kasemsri Srisupun ◽  
Suchaya Luewan ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Pregnant Women ◽  
False Positive ◽  
Detection Rate ◽  
False Positive Rate ◽  
Nasal Bone ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Ductus Venosus ◽  
Positive Rate

Abstract Background: To evaluate the performance of first trimester sonomarkers in the detection of fetal Down syndrome among Thai pregnant womenMethods: Pregnant women at 11-13+6 weeks’ gestation underwent ultrasound examination for assessment of nuchal translucency (NT), nasal bone (NB), tricuspid regurgitation (TR), and abnormal ductus venosus (aDV) Doppler waveforms. The women were followed up for final outcomes. Fetal abnormalities other than trisomy 21 were excluded. The performances of each sonomarker and their combinations in predicting fetal Down syndrome were calculated.Results: A total of 7,820 pregnant women meeting the inclusion criteria were available for analysis, including 20 cases with fetal Down syndrome and 7,800 unaffected cases. Of the four sonomarkers, NT, as a single sonomarker, had the highest detection rate (55.0% at a false positive rate of about 5%), whereas the remaining single sonomarkers had low detection rate (15-20%). The combination of all sonomarkers had the highest detection rate of 70% but the false positive rate was as high as 10.8%. The combination of NT and NB had a detection rate of 60% with an acceptable false positive rate of 6.9%, whereas the other combinations yielded relatively high false positive rates. Conclusion: The first trimester genetic sonogram in screening for Down syndrome among Asian women is acceptably effective and may be offered to some selected groups of the population. NT is the best sonomarker with a detection rate of 55% at 5% false positive rate and its combination with NB can improve performance with minimal increase in false positive rate.

THE MODEL SCREENING PREECLAMPSIA AT 11+0 TO 13+6 WEEKS OF GESTATION

2015 ◽  
pp. 162-172
Author(s):  
Ngoc Thanh Cao ◽  
Vu Quoc Huy Nguyen ◽  
Van Duc Vo ◽  
Quang Vinh Truong ◽  
Viet Nhan Nguyen ◽  
...  
Keyword(s):  
False Positive ◽  
Gestational Hypertension ◽  
False Positive Rate ◽  
Outcome Data ◽  
Maternal Factors ◽  
Hospital Visit ◽  
Detection Rates ◽  
Maternal Characteristics ◽  
Screening Study ◽  
Positive Rate

Objective: Screening preeclampsia at 11+0-13+6 gestational by combine maternal characteristics, MAP, PAPP-A and UtA-PI. Materials and methods: Prospective screening study for preeclampsia in pregnant attending their first hospital visit at 11-13 weeks 6 of gestation. The performance of screening for PE and GH by combinations of maternal characteristics, uterine artery with the lowest pulsatility index (L-PI), mean arterial pressure (MAP) and serum PAPP-A was determined. Results: Of 2,998 patients with complete outcome data, there were 3.74% of hypertension disorder, and 2.84% cases of pre-eclampsia. The study show a poor results screening for PE by maternal factors only. In screening for PE by combine maternal factors, MAP and L-PI, the estimated detection rates were 18,2% and 45,5% for HG, 45,6% and 57,9% for late PE at a fixed false positive rate of 5% and 10%, respectively.For early PE, in screening by combine maternal characteristics, L-PI, MAP and serum PAPP-A, the the estimated detection rates were 81,8% and 90,9% at at a fixed false positive rate of 5% and 10%, respectively. Conclusion: Effective prediction of early PE can be achieved at 11–13+6 weeks’ gestation by combine maternal characteristics, L-PI, MAP and serum PAPP-A. Key words: preeclampsia; gestational hypertension; screening; PAPP-A, UtA-PI, MAP

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