A novel approach to first-trimester screening for early pre-eclampsia combining serum PP-13 and Doppler ultrasound.
OBJECTIVE
To investigate the value of maternal serum placental protein 13 (PP-13) measurement and uterine artery Doppler during first-trimester screening in the prediction of early pre-eclampsia.


METHODS
This was a nested case-control prospective study of pregnancies at 11 + 0 to 13 + 6 weeks of gestation. The pulsatility index (PI) of blood flow in the uterine arteries and the maternal serum concentration of PP-13 were measured in 10 women who went on to develop pre-eclampsia that necessitated delivery before 34 weeks, and in 423 unaffected women. Results were expressed as multiples of the gestation-specific median in controls (MoM). A logistic regression model was used to predict detection and false-positive rates.


RESULTS
In the cases that developed pre-eclampsia requiring delivery before 34 weeks, compared with the unaffected pregnancies, the median uterine artery PI was higher (1.43 MoM) and the median serum PP-13 level was lower (0.07 MoM; P < 0.001, Wilcoxon rank sum test for both). Modeling predicted that for a 90% detection rate of pre-eclampsia requiring delivery before 34 weeks, the false-positive rate of screening by PP-13 was 12%, by uterine artery PI was 31% and by a combination of the two methods was 9%. A policy of contingency screening, whereby all women are screened by maternal serum PP-13 and only the 14% at highest risk are then screened by Doppler, achieved a detection rate of 90% with an overall false-positive rate of 6%.


CONCLUSIONS
Effective screening for pre-eclampsia requiring delivery before 34 weeks can potentially be provided by assessment of a combination of maternal serum PP-13 and uterine artery Doppler in the first trimester of pregnancy.
Nicolaides
K H
KH
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Bindra
R
R
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Turan
O M
OM
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Chefetz
I
I
Diagnostic Technologies Ltd, Haifa, Israel.
Sammar
M
M
Diagnostic Technologies Ltd, Haifa, Israel.
Meiri
H
H
Diagnostic Technologies Ltd, Haifa, Israel.
Tal
J
J
TechnoStat Ltd, Kfar Saba, Israel.
Cuckle
H S
HS
Reproductive Epidemiology, University of Leeds, Leeds, UK.
D000328:Adult; D001158:Arteries / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D037161:Galectins / Q000097:blood*; D006801:Humans; D008423:Maternal Age; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000503:physiopathology; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011261:Pregnancy Trimester, First; D011673:Pulsatile Flow; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014599:Uterus / Q000098:blood supply
D015415:Biomarkers; D037161:Galectins; C038195:LGALS13 protein, human; D011257:Pregnancy Proteins