Authors (including presenting author) :
Ho SY (1), Lee LT(1), Chan LW(1)
Affiliation :
(1) Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital
Introduction :
Preeclampsia (PE) is one of the leading causes of maternal mortality worldwide. Early PE screening is recommended by international organisations, and our unit began universal first-trimester PE screening in 2022 based on Fetal Medicine Foundation methodologies, with maternal factors, mean arterial pressure, uterine artery Doppler and pregnancy-associated plasma protein-A, without requiring additional laboratory costs.
Objectives :
To evaluate the effectiveness of our PE screening versus the current local approach (maternal history by National Institute for Health and Care Excellence criteria, hereafter the NICE approach), when implemented in a peripheral hospital with a predominantly Asian population.
Methodology :
This was a retrospective, non-intervention study. 1860 pregnancies who received PE screening in our unit from 1/5/2022 to 31/12/2023 and subsequently delivered in HA were included. This same group also had the NICE approach retrospectively applied, and adjustments were made for the effects of aspirin on preterm PE for those who received it. Primary outcomes were detection rates of preterm and term PE of our approach, compared to the NICE approach. Secondary outcomes were delivery outcomes of those with preterm PE, and of those who were positively identified by our approach versus the false negatives.
Result & Outcome :
For preterm PE detection rate, first trimester screening by our approach was superior to the current NICE approach (80% vs 55%, p=0.031). For total PE detection rate, our approach was also superior (67.8% vs 45.8%, p=0.015).
Those that eventually developed preterm PE had significantly worse foetal outcomes including lower gestational ages (32.3 vs 38.8 weeks, p< 0.001), lower birth weights at delivery (1499 vs 3044g, p< 0.001), and higher rates of neonatal unit admission (66.7% vs 15.4%, p< 0.001). Comparing those who were accurately predicted by our approach versus those who were not successfully picked up i.e. false negatives, there were no significant differences in most maternal-foetal outcomes, except that magnesium sulphate (MgSO4) use was significantly more common among the true positives (92.3% vs 37.5%, p=0.007).
Conclusion:
First trimester PE screening by our approach provides superior detection rates compared to the existing NICE approach in the local population. The approach brings no material impact to budgets or workflows, but still identifies many more high-risk pregnancies that would benefit from low-dose aspirin, thereby preventing many cases of preterm PE and its maternal-foetal complications.
