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Third-trimester prediction of preeclampsia

Lai, J; (2017) Third-trimester prediction of preeclampsia. Doctoral thesis , UCL (University College London).

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Abstract

Preeclampsia (PE) is a common complication of pregnancy affecting upto 10% of the population. Screening in the UK has centred on identifying risk factors early in pregnancy, in order to determine the need for aspirin administration for risk prevention. Whilst screening late on, has no role in treatment or prevention of disease, it does serve a vital role in the stratification of a timely delivery. Recent studies have highlighted the importance of such an approach in improving maternal and fetal morbidity and mortality. In the cohort-control study, stored plasma from 50 cases that developed PE at or after 34 weeks were matched with 250 unaffected controls. At 11-13 weeks in the PE group compaired to controls, serum PAPP-A and PlGF were lower (0.748 and 0.824 vs 1.0 MoM), but free b-hCG, sEng and activin-A were not significantly different. At 30-33 weeks, in the PE group, there was a decrease in PlGF (0.356 MoM), increase in free β-hCG (1.750 MoM), sEng (1.390 MoM) and activin-A (1.47 MoM), but PAPP-A was not significantly different from controls. The uterine artery PI, MAP, sBP and dBP were assessed in a screening population of 4,294 with detections rate of upto 70% of intermediate PE. A survival time model for the time of delivery for PE by combination of maternal characteristics and history with PlGF and sFlt-1 multiple of the median (MoM) values was devised. Screening by the biochemical test detected 100%, 76%, and 62% of PE with delivery within four, six and eight weeks of the visit, at a fixed false positive rate of 5%. In conclusion, although both biochemical and biophysical tests are useful in the detection of PE, using the angiogenic markers alone at 30-33 weeks can effectively identify all women who require delivery due to PE in the subseqeunt 4 weeks from testing.

Type: Thesis (Doctoral)
Title: Third-trimester prediction of preeclampsia
Event: UCL (University College London)
Language: English
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: http://discovery.ucl.ac.uk/id/eprint/1561522
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