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Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better?
Abstract Objective 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. Study design Prospective cohort study in 61 singleton pregnancies. Uterine artery Doppler and place...
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Published in: | Placenta (Eastbourne) 2008-12, Vol.29 (12), p.1034-1040 |
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description | Abstract Objective 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. Study design 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). Results 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 ≥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 ≥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). Conclusions 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. |
doi_str_mv | 10.1016/j.placenta.2008.09.004 |
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Study design 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). Results 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 ≥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 ≥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). Conclusions 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.</description><identifier>ISSN: 0143-4004</identifier><identifier>EISSN: 1532-3102</identifier><identifier>DOI: 10.1016/j.placenta.2008.09.004</identifier><identifier>PMID: 18930542</identifier><identifier>CODEN: PLACDF</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Adult ; Adverse perinatal outcome ; Arteries - diagnostic imaging ; Biological and medical sciences ; Early Diagnosis ; Embryology: invertebrates and vertebrates. Teratology ; Female ; First and second trimesters ; Fundamental and applied biological sciences. Psychology ; Humans ; Internal Medicine ; Mass Screening ; Maternal serum screening ; Middle Aged ; Obstetrics and Gynecology ; Pilot Projects ; Placenta - blood supply ; Placenta - diagnostic imaging ; Placental Insufficiency - diagnostic imaging ; Placental Insufficiency - epidemiology ; Placental morphology ; Placental pathology ; Predictive Value of Tests ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Prospective Studies ; Risk Factors ; Ultrasonography, Doppler ; Uterine artery Doppler ; Young Adult</subject><ispartof>Placenta (Eastbourne), 2008-12, Vol.29 (12), p.1034-1040</ispartof><rights>Elsevier Ltd</rights><rights>2008 Elsevier Ltd</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-a5d542c58c4dbe30b160e871eada3b5bdc921fb5539ff7fb9f731453fb58e47a3</citedby><cites>FETCH-LOGICAL-c451t-a5d542c58c4dbe30b160e871eada3b5bdc921fb5539ff7fb9f731453fb58e47a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20955965$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18930542$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Costa, S.L</creatorcontrib><creatorcontrib>Proctor, L</creatorcontrib><creatorcontrib>Dodd, J.M</creatorcontrib><creatorcontrib>Toal, M</creatorcontrib><creatorcontrib>Okun, N</creatorcontrib><creatorcontrib>Johnson, J.-A</creatorcontrib><creatorcontrib>Windrim, R</creatorcontrib><creatorcontrib>Kingdom, J.C.P</creatorcontrib><title>Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better?</title><title>Placenta (Eastbourne)</title><addtitle>Placenta</addtitle><description>Abstract Objective 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. Study design 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). Results 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 ≥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 ≥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). Conclusions 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.</description><subject>Adult</subject><subject>Adverse perinatal outcome</subject><subject>Arteries - diagnostic imaging</subject><subject>Biological and medical sciences</subject><subject>Early Diagnosis</subject><subject>Embryology: invertebrates and vertebrates. Teratology</subject><subject>Female</subject><subject>First and second trimesters</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Mass Screening</subject><subject>Maternal serum screening</subject><subject>Middle Aged</subject><subject>Obstetrics and Gynecology</subject><subject>Pilot Projects</subject><subject>Placenta - blood supply</subject><subject>Placenta - diagnostic imaging</subject><subject>Placental Insufficiency - diagnostic imaging</subject><subject>Placental Insufficiency - epidemiology</subject><subject>Placental morphology</subject><subject>Placental pathology</subject><subject>Predictive Value of Tests</subject><subject>Pregnancy</subject><subject>Pregnancy Trimester, First</subject><subject>Pregnancy Trimester, Second</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Ultrasonography, Doppler</subject><subject>Uterine artery Doppler</subject><subject>Young Adult</subject><issn>0143-4004</issn><issn>1532-3102</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqFkU1v1DAQhi0EokvhL1S-wC1hHNvZmANfVaErVaKicLYcZ7x4m3UWO0Haf4_DBpC4cLI0fuad0TOEXDAoGbD65a489MZiGE1ZATQlqBJAPCArJnlVcAbVQ7ICJnghcv2MPElpBwBKsOoxOWON4iBFtSKf72xEDD5sqRsivV1Ce7oJaXLOW4_BHqkP9NpvvxXRp3t6G3EbTMhf6RXdJHplYu8x0vc4jhjfPCWPnOkTPlvec_L1w9WXy-vi5tPHzeW7m8IKycbCyC5vYGVjRdcih5bVgM2aoekMb2XbWVUx10rJlXNr1yq35kxInksNirXh5-TFKfcQh-8TplHvfbLY9ybgMCVdq4YLxVkG6xNo45BSRKcP0e9NPGoGerapd_q3TT3b1KB0tpYbL5YJU7vH7m_boi8DzxfAJGt6F2cr6Q9XgZJS1TJzb08cZh8_siudfonFzke0o-4G__9dXv8TYXsffJ56j0dMu2GKIdvWTKdKg76bbz-fHhoADnXDfwJBhasv</recordid><startdate>20081201</startdate><enddate>20081201</enddate><creator>Costa, S.L</creator><creator>Proctor, L</creator><creator>Dodd, J.M</creator><creator>Toal, M</creator><creator>Okun, N</creator><creator>Johnson, J.-A</creator><creator>Windrim, R</creator><creator>Kingdom, J.C.P</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20081201</creationdate><title>Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better?</title><author>Costa, S.L ; Proctor, L ; Dodd, J.M ; Toal, M ; Okun, N ; Johnson, J.-A ; Windrim, R ; Kingdom, J.C.P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-a5d542c58c4dbe30b160e871eada3b5bdc921fb5539ff7fb9f731453fb58e47a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adult</topic><topic>Adverse perinatal outcome</topic><topic>Arteries - diagnostic imaging</topic><topic>Biological and medical sciences</topic><topic>Early Diagnosis</topic><topic>Embryology: invertebrates and vertebrates. Teratology</topic><topic>Female</topic><topic>First and second trimesters</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Mass Screening</topic><topic>Maternal serum screening</topic><topic>Middle Aged</topic><topic>Obstetrics and Gynecology</topic><topic>Pilot Projects</topic><topic>Placenta - blood supply</topic><topic>Placenta - diagnostic imaging</topic><topic>Placental Insufficiency - diagnostic imaging</topic><topic>Placental Insufficiency - epidemiology</topic><topic>Placental morphology</topic><topic>Placental pathology</topic><topic>Predictive Value of Tests</topic><topic>Pregnancy</topic><topic>Pregnancy Trimester, First</topic><topic>Pregnancy Trimester, Second</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Ultrasonography, Doppler</topic><topic>Uterine artery Doppler</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Costa, S.L</creatorcontrib><creatorcontrib>Proctor, L</creatorcontrib><creatorcontrib>Dodd, J.M</creatorcontrib><creatorcontrib>Toal, M</creatorcontrib><creatorcontrib>Okun, N</creatorcontrib><creatorcontrib>Johnson, J.-A</creatorcontrib><creatorcontrib>Windrim, R</creatorcontrib><creatorcontrib>Kingdom, J.C.P</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Placenta (Eastbourne)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Costa, S.L</au><au>Proctor, L</au><au>Dodd, J.M</au><au>Toal, M</au><au>Okun, N</au><au>Johnson, J.-A</au><au>Windrim, R</au><au>Kingdom, J.C.P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better?</atitle><jtitle>Placenta (Eastbourne)</jtitle><addtitle>Placenta</addtitle><date>2008-12-01</date><risdate>2008</risdate><volume>29</volume><issue>12</issue><spage>1034</spage><epage>1040</epage><pages>1034-1040</pages><issn>0143-4004</issn><eissn>1532-3102</eissn><coden>PLACDF</coden><abstract>Abstract Objective 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. Study design 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). Results 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 ≥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 ≥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). Conclusions 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.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>18930542</pmid><doi>10.1016/j.placenta.2008.09.004</doi><tpages>7</tpages></addata></record> |
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subjects | Adult Adverse perinatal outcome Arteries - diagnostic imaging Biological and medical sciences Early Diagnosis Embryology: invertebrates and vertebrates. Teratology Female First and second trimesters Fundamental and applied biological sciences. Psychology Humans Internal Medicine Mass Screening Maternal serum screening Middle Aged Obstetrics and Gynecology Pilot Projects Placenta - blood supply Placenta - diagnostic imaging Placental Insufficiency - diagnostic imaging Placental Insufficiency - epidemiology Placental morphology Placental pathology Predictive Value of Tests Pregnancy Pregnancy Trimester, First Pregnancy Trimester, Second Prospective Studies Risk Factors Ultrasonography, Doppler Uterine artery Doppler Young Adult |
title | Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better? |
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