title: Prediction of stillbirth from biochemical and biophysical markers at 11-13 weeks.
abstract: OBJECTIVE
  To develop a model for the prediction of stillbirth that is based on a combination of maternal characteristics and medical history with first-trimester biochemical and biophysical markers and to evaluate the performance of screening with this model for all stillbirths and those due to impaired placentation and unexplained causes.
  
  
  METHODS
  This was a prospective screening study of 76 897 singleton pregnancies, including 76 629 live births and 268 (0.35%) antepartum stillbirths; 157 (59%) were secondary to impaired placentation and 111 (41%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to determine if there was a significant contribution to prediction of stillbirth from the maternal factor-derived a-priori risk, fetal nuchal translucency thickness, ductus venosus pulsatility index for veins (DV-PIV), uterine artery pulsatility index (UtA-PI) and maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A (PAPP-A). The significant contributors were used to derive a model for first-trimester prediction of stillbirth.
  
  
  RESULTS
  Significant contribution to prediction of stillbirth was provided by maternal factors, PAPP-A, UtA-PI and DV-PIV. A model combining these variables predicted 40% of all stillbirths and 55% of those due to impaired placentation, at a false-positive rate of 10%. Within the impaired-placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (64% vs 42%).
  
  
  CONCLUSIONS
  A model based on maternal factors and first-trimester biomarkers can potentially predict more than half of subsequent stillbirths that occur due to impaired placentation. The extent to which such stillbirths could be prevented remains to be determined. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors: S
authors: S
authors: Mastrodima
authors: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.|Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, UK.
authors: R
authors: R
authors: Akolekar
authors: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors: G
authors: G
authors: Yerlikaya
authors: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors: T
authors: T
authors: Tzelepis
authors: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors: K H
authors: KH
authors: Nicolaides
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D050498:Live Birth / Q000453:epidemiology; D016015:Logistic Models; D008962:Models, Theoretical; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011446:Prospective Studies; D050497:Stillbirth / Q000453:epidemiology*
chemical_list: D015415:Biomarkers
keywords: ductus venosus Doppler; first-trimester screening; pyramid of pregnancy care; serum PAPP-A; stillbirth; uterine artery Doppler