MATERNAL SERUM PAPP-A LEVELS AT 11+0 TO 13+6 WEEKS OF GESTATION IN THE PREDICTION OF HYPERTENSION DISORDER

2015 ◽  
pp. 143-152
Author(s):  
Ngoc Thanh Cao ◽  
Van Duc Vo ◽  
Vu Quoc Huy Nguyen ◽  
Quang Vinh Truong ◽  
Viet Nhan Nguyen ◽  
...  
Keyword(s):  
False Positive ◽  
Gestational Hypertension ◽  
False Positive Rate ◽  
First Trimester ◽  
Outcome Data ◽  
Maternal Serum ◽  
Control Group ◽  
Detection Rates ◽  
Screening Study ◽  
Positive Rate

Objective: To detect maternal serum PAPP-A levels at 11-13 weeks 6 day of gestation in pregnancies who subsequently develop pre-eclampsia and to evaluating the role of these screening PAPP-A in the prediction of pre-eclampsia. 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 by serum PAPP-A and free βhCG were determined. Results: Of 2,998 patients with complete outcome data, there were 3.74% of hypertension disorder, and 2.84% cases of pre-eclampsia. free βhCG levels were no different significantly in pregnancy who developed pre-eclampsia compared to the control group. PAPP-A levels were significantly lower in pregnants who developed early pre-eclampsia (0.653 MoM) and late pre-eclampsia (0.744 MoM) compared to the control group (1.039 MoM).In screening for PE by combinematernal factors and PAPP-A,at false positive rate of 5%, the estimateddetection rates were 36.4% and the detection rates were 54.6%, at at false positive rate of 10%. Conclusion: Low PAPP-A levels are associated with the development of preeclampsia; however, it should be combined with other tests to increase effectiveness of hypertension disorder screening at the first trimester. Key words: preeclampsia; gestational hypertension; screening; PAPP-A.

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

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.

scholarly journals Screening for aneuploidies by maternal age, fetal nuchal translucency and maternal serum biochemistry at 11-13+6 gestational weeks

2012 ◽  
Vol 140 (9-10) ◽  
pp. 606-611 ◽  
Author(s):  
Natasa Karadzov-Orlic ◽  
Amira Egic ◽  
Dejan Filimonovic ◽  
Maja Marinkovic ◽  
Barbara Damnjanovic-Pazin ◽  
...  
Keyword(s):  
False Positive ◽  
Trisomy 21 ◽  
Maternal Age ◽  
False Positive Rate ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Maternal Serum ◽  
Trisomy 18 ◽  
Serum Free ◽  
Positive Rate

Introduction. Aneuploidies are the major cause of perinatal death and early psychophysical disorders. Objective. In this study, we analyzed detection and false-positive rates of screening for aneuploidies in the first trimester by the combination of maternal age, fetal nuchal translucency (NT) thickness and maternal serum free beta-human chorionic gonadotrophin (?-hCG), and pregnancy-associated plasma protein-A (PAPP-A) at 11-13+6 weeks of gestation, using the appropriate software developed by the Fetal Medicine Foundation. Methods. Our screening study for aneuploidies analyzed 4172 singleton pregnancies from January 2006 to December 2010. The sensitivities and false-positive rates using the combined aneuploidies determination for the risk cut-off of 1:275 were evaluated. Results. In the trisomy 21 pregnancies, the fetal NT was higher than 95th centile, in 72.8%, serum free b-hCG concentration it was above the 95th centile in 55% and serum PAPP-A was below the 5th centile in 47% of the cases. In the trisomy 18 and 13, the fetal NT was above 95th centile in 66.6% and 44.4% of the cases, respectively. The serum free b-hCG concentration was above the 95th centile in 0 and 10%, but serum PAPP-A was below 5th centile in 80.9% and 88.8% of pregnancies. In the trisomy 21 pregnancies the median free beta-hCG was 2.3 MoM and the median PAPP-A was 0.45 MoM. Chromosomal abnormalities were detected in 169 fetuses: trisomy 21 (97), Turner syndrome (19), trisomy 18 (28), trisomy 13 (11) and others (14). Detection rate of combined screening for aneuploides were 86.0% with false positive rate of 5.3% (mean age 33?4.9 years, >35 years in 35% of pregnancies). Conclusion. Our study suggests that the strategy of first-trimester combined screening of biochemical values and ultrasonographic parameters at 12 gestational weeks identifies higher percentage of aneuploidies with a lower false-positive rate than a single parameter strategy.

Predicting Fetal Chromosome Anomalies in the First Trimester Using Pregnancy Associated Plasma Protein-A: A Comparison of Statistical Methods

1993 ◽  
Vol 32 (02) ◽  
pp. 175-179 ◽  
Author(s):  
B. Brambati ◽  
T. Chard ◽  
J. G. Grudzinskas ◽  
M. C. M. Macintosh
Keyword(s):  
Logistic Regression ◽  
General Population ◽  
Likelihood Ratio ◽  
False Positive ◽  
False Positive Rate ◽  
Ratio Method ◽  
Detection Rates ◽  
Gaussian Distributions ◽  
Positive Rate ◽  
Likelihood Ratio Method

Abstract:The analysis of the clinical efficiency of a biochemical parameter in the prediction of chromosome anomalies is described, using a database of 475 cases including 30 abnormalities. A comparison was made of two different approaches to the statistical analysis: the use of Gaussian frequency distributions and likelihood ratios, and logistic regression. Both methods computed that for a 5% false-positive rate approximately 60% of anomalies are detected on the basis of maternal age and serum PAPP-A. The logistic regression analysis is appropriate where the outcome variable (chromosome anomaly) is binary and the detection rates refer to the original data only. The likelihood ratio method is used to predict the outcome in the general population. The latter method depends on the data or some transformation of the data fitting a known frequency distribution (Gaussian in this case). The precision of the predicted detection rates is limited by the small sample of abnormals (30 cases). Varying the means and standard deviations (to the limits of their 95% confidence intervals) of the fitted log Gaussian distributions resulted in a detection rate varying between 42% and 79% for a 5% false-positive rate. Thus, although the likelihood ratio method is potentially the better method in determining the usefulness of a test in the general population, larger numbers of abnormal cases are required to stabilise the means and standard deviations of the fitted log Gaussian distributions.

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 First Trimester Biochemical Screening for Trisomy 21: The Role of Free Beta hCG, Alpha Fetoprotein and Pregnancy Associated Plasma Protein A

1994 ◽  
Vol 31 (5) ◽  
pp. 447-454 ◽  
Author(s):  
K Spencer ◽  
D A Aitken ◽  
J A Crossley ◽  
G McCaw ◽  
E Berry ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Plasma Protein ◽  
Human Chorionic Gonadotropin ◽  
Trisomy 21 ◽  
False Positive Rate ◽  
Protein A ◽  
First Trimester ◽  
Serum Markers ◽  
Maternal Serum ◽  
Detection Rates

The potential efficacy of screening for trisomy 21 in the first trimester, using maternal serum markers α fetoprotein, free β human chorionic gonadotropin, unconjugated oestriol and pregnancy associated plasma protein A, was studied in an unselected population of women between the seventh and fourteenth week of gestation. Using a combination of α fetoprotein and free β human chorionic gonadotropin, 53% of affected pregnancies could be identified at a false positive rate of 5%. Unconjugated oestriol and pregnancy associated plasma protein A levels were lower in cases of trisomy 21, but their inclusion with other markers did not significantly improve detection rate. Monitoring the same pregnancies also in the second trimester showed that screening in the first trimester identified the same cases as in the second. We conclude that first trimester screening using free β human chorionic gonadotropin and α fetoprotein, is a viable possibility and will lead to detection rates in excess of 50%. Prospective studies are needed to confirm these observations.

The efficacy of combining several risk factors as a screening test

2005 ◽  
Vol 12 (4) ◽  
pp. 197-201 ◽  
Author(s):  
Nicholas J Wald ◽  
Joan K Morris ◽  
Simon Rish
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
False Positive ◽  
Detection Rate ◽  
False Positive Rate ◽  
Individual Risk ◽  
Detection Rates ◽  
Screening Performance ◽  
Positive Rate ◽  
The Individual

Objective: To determine the quantitative effect on overall screening performance (detection rate for a given false-positive rate) of using several moderately strong, independent risk factors in combination as screening markers. Setting: Theoretical statistical analysis. Methods: For the purposes of this analysis, it was assumed that all risk factors were independent, had Gaussian distributions with the same standard deviation in affected and unaffected individuals and had the same screening performance. We determined the overall screening performance associated with using an increasing number of risk factors together, with each risk factor having a detection rate of 10%, 15% or 20% for a 5% false-positive rate. The overall screening performance was estimated as the detection rate for a 5% false-positive rate. Results: Combining the risk factors increased the screening performance, but the gain in detection at a constant false-positive rate was relatively modest and diminished with the addition of each risk factor. Combining three risk factors, each with a 15% detection rate for a 5% false-positive rate, yields a 28% detection rate. Combining five risk factors increases the detection rate to 39%. If the individual risk factors have a detection rate of 10% for a 5% false-positive rate, it would require combining about 15 such risk factors to achieve a comparable overall detection rate (41%). Conclusion: It is intuitively thought that combining moderately strong risk factors can substantially improve screening performance. For example, most cardiovascular risk factors that may be used in screening for ischaemic heart disease events, such as serum cholesterol and blood pressure, have a relatively modest screening performance (about 15% detection rate for a 5% false-positive rate). It would require the combination of about 15 or 20 such risk factors to achieve detection rates of about 80% for a 5% false-positive rate. This is impractical, given the risk factors so far discovered, because there are too few risk factors and their associations with disease are too weak.

Maternal Serum PAPP-A as an Early Marker of Obstetric Complications?

2014 ◽  
Vol 37 (1) ◽  
pp. 33-36 ◽  
Author(s):  
Tommasa Quattrocchi ◽  
Giovanni Baviera ◽  
Teresa Pochiero ◽  
Francesca Basile ◽  
Laura Rizzo ◽  
...  
Keyword(s):  
Gestational Hypertension ◽  
Adverse Pregnancy Outcome ◽  
First Trimester ◽  
Maternal Serum ◽  
Control Group ◽  
Retrospective Case ◽  
Intrauterine Growth ◽  
Term Delivery ◽  
Adverse Pregnancy ◽  
Control Study

Objective: The aim of this study was to investigate whether low first-trimester PAPP-A levels are associated with an adverse pregnancy outcome. Materials and Methods: A retrospective case-control study was carried out using a Down's syndrome assays database over a 6-year period, between the 8th and 11th week of pregnancy. There were 164 women with PAPP-A multiples of median (MoM) levels <0.3 and 1,640 women with PAPP-A MoM levels ≥0.3 who served as a control group. Outcome measures were the prevalence of miscarriages, gestational hypertension, preeclampsia, pre-term delivery, gestational diabetes and intrauterine growth retardation in both groups. Results: The two groups significantly differed only for miscarriages: 29 (17.7%) vs. 159 (9.7%), p = 0.04, OR 1.7; gestational hypertension: 15 (9.1%) vs. 74 (4.5%), p = 0.02, OR 2.1, and preeclampsia: 9 (5.5%) vs. 29 (1.8%), p = 0.02, OR 2.5. Discussion: Even if in this study the PAPP-A cutoff considered was lower and was assayed in an earlier period compared with other studies, the detection rate for adverse pregnancy outcomes did not improve.

scholarly journals Screening for Hypertensive Pregnancy Complications through Maternal Serum PAPP-A 5th and 10th Percentiles during the 11-14 Weeks Gestational Age Interval

2020 ◽  
Vol 71 (2) ◽  
pp. 262-266
Author(s):  
Voicu Dascau ◽  
Gheorghe Furau ◽  
Luminita Pilat ◽  
Cristina Onel ◽  
Maria Puschita
Keyword(s):  
Gestational Age ◽  
Predictive Value ◽  
False Positive ◽  
False Positive Rate ◽  
Protein A ◽  
Maternal Serum ◽  
Predictive Values ◽  
Induced Hypertension ◽  
Positive Rate ◽  
Mild Preeclampsia

The aim of our study was to assess the predictive values for hypertensive complications of pregnancy of the multiples of median (MoM) of serum pregnancy associated plasma protein A (PAPP-A), measured in 128 pregnant patients between 11 and 14 weeks gestational age. The 5th and the 10th percentile for MoM PAPP-A were 0.27 and 0.33, respectively. The detection rate for pregnancy induced hypertension, mild preeclampsia, severe preeclampsia, all preeclampsia and all hypertensive complications was 0%, 9.09%, 0%, 7.69%, and 6.25% for MoM PAPP-A below the 5th percentile (for a false positive rate of 5%), and 33.33%, 9.09%, 0%, 7.69%, and 12.5% for MoM PAPP-A below the 10th percentile (for a false positive rate of 10%), respectively. The specificity ranged from 89.57% to 95.73%, the positive predictive value from 0% to 16.67%, and the negative predictive value from 87.70% to 98.36%.

Placental protein-13 (PP13) in combination with PAPP-A and free leptin index (fLI) in first trimester maternal serum screening for severe and early preeclampsia

2017 ◽  
Vol 56 (1) ◽  
Author(s):  
Carin P. De Villiers ◽  
Paula L. Hedley ◽  
Sophie Placing ◽  
Karen R. Wøjdemann ◽  
Anne-Cathrine Shalmi ◽  
...  
Keyword(s):  
Detection Rate ◽  
False Positive Rate ◽  
First Trimester ◽  
Serum Marker ◽  
Maternal Serum ◽  
Maternal Serum Screening ◽  
Discriminatory Ability ◽  
Screening Performance ◽  
Positive Rate ◽  
Placental Protein

AbstractBackground:Placental protein-13 (PP13) is involved in placental invasion and has been suggested as a maternal serum marker of preeclampsia (PE) development. However, the discriminatory ability of PP13 in first trimester has not been completely clarified.Methods:PP13 was measured in first trimester (week 10Results:In severe PE (including HELLP) cases (n=26) the median PP13 concentration was 35.8 pg/mL (range: 17.8–85.5 pg/mL) and in PE pregnancies (n=10) with birth prior to week 34, the median PP13 concentration was 30.6 pg/mL (13.1–50.1 pg/mL), compared to controls with a median of 54.8 pg/mL (range: 15.4–142.6 pg/mL) (p<0.04). The population screening detection rate (DR) for a false-positive rate of 10% for severe PE and HELLP was 26% for PP13, 28% for PP13+PAPP-A, 33% for PP13+fLI, and 40% for PP13+PAPP-A+fLI.Conclusions:PP13 is a marker of severe PE and HELLP syndrome. The screening performance of PP13 can be markedly improved by combining it with fLI and PAPP-A.

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