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https://hdl.handle.net/2440/53184
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Type: | Journal article |
Title: | Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better? |
Author: | Costa, S. Proctor, L. Dodd, J. Toal, M. Okun, N. Johnson, J. Windrim, R. Kingdom, J. |
Citation: | Placenta, 2008; 29(12):1034-1040 |
Publisher: | W B Saunders Co Ltd |
Issue Date: | 2008 |
ISSN: | 0143-4004 1532-3102 |
Statement of Responsibility: | S.L. Costa, L. Proctor, J.M. Dodd, M. Toal, N. Okun, J.-A. Johnson, R. Windrim and J.C.P. Kingdom |
Abstract: | <h4>Objective</h4>To compare a profile of placental function between the first and second trimesters in pregnancies at high risk of adverse perinatal outcomes attributable to placental insufficiency.<h4>Study design</h4>Prospective cohort study in 61 singleton pregnancies. Uterine artery Doppler and placental morphology (shape and texture) were determined at 11-13(+6) weeks and at 18-23(+6) weeks. First trimester (pregnancy-associated placental protein-A [PAPP-A]) and second trimester (total hCG and alpha fetoprotein [AFP]) serum biochemistry were determined. The two screening periods were compared for the prediction of a range of severe adverse perinatal outcomes (intrauterine growth restriction [IUGR], abruption, severe pre-eclampsia/HELLP syndrome, delivery<32 weeks, or stillbirth).<h4>Results</h4>Adverse perinatal outcomes occurred in 14 (23%) women; 3 (4.9%) losses<20 weeks, 2 (3.3%) stillbirths>20 weeks, 4 (6.6%) IUGR, 7 (11.5%) severe pre-eclampsia/HELLP syndrome, and 10 (16.4%) deliveries<32 weeks. Abnormal second trimester placental morphology was significantly associated with adverse outcome [+LR: 3.6, 95% CI: 1.3-8.5; -LR: 0.63, 95% CI: 0.36-0.93; p=0.025], as was > or = 1 abnormal second trimester tests [+LR: 5.9, 95% CI: 1.6-24; -LR: 0.68, 95% CI: 0.59-0.89; p=0.005] or > or = 2 abnormal second trimester tests [+LR: 3.6, 95% CI: 1.3-7.7; -LR: 0.58, 95% CI: 0.27-0.94; p=0.035]. No combination of first trimester tests significantly predicted severe adverse perinatal outcomes. A study sample size of 822 women with similar high-risk characteristics would be needed in order to refute the conclusion that present methods of first trimester screening are not inferior to second trimester screening for severe placental insufficiency (p=0.05, power 80%, z-test).<h4>Conclusions</h4>In clinically high-risk pregnancies, prediction of adverse perinatal outcomes using placental function testing is more effective in the second compared with the first trimester. |
Keywords: | Maternal serum screening First and second trimesters Uterine artery Doppler Placental morphology Adverse perinatal outcome Placental pathology |
DOI: | 10.1016/j.placenta.2008.09.004 |
Published version: | http://dx.doi.org/10.1016/j.placenta.2008.09.004 |
Appears in Collections: | Aurora harvest 5 Obstetrics and Gynaecology publications |
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