The model of screening for preeclampsia in the second and third trimesters of gestation
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Department of Obstetrics and Gynecology, Odesa National Medical University, Odesa, UKRAINE
Department of Simulation Medical Technologies, Odessa National Medical University, Odesa, UKRAINE
Online publication date: 2023-02-25
Publication date: 2023-05-01
Electron J Gen Med 2023;20(3):em473
Preeclampsia (PE) is a specific syndrome of multiple organ insufficiency in case of pregnancy, which is included in the panel of major obstetric syndromes and is among the main causes of maternal morbidity and mortality in the whole world.

Material and Methods:
We conducted a prospective cohort study of 91 pregnant women to evaluate the effectiveness of integrated use of maternal risk factors (2019 International Federation of Gynecology and Obstetrics recommendations), placenta location (ultrasound at 18-20 weeks of gestation), and serum cystatin C (at 18-36 weeks of gestation) in screening for pe in the second and third trimesters of gestation.

In the subgroup of pregnant women with cystatin C levels greater than 1.0 mg/L (27 women), PE developed in 26 women, which is 96.29% in percentage terms. When calculating GFR for cystatin C in a group with PE there was a significant violation of the renal filtration system -52.46±2.08 (95% CI, 48.39-56.54), while in healthy group the indicator is within normal limits -97.6±1.64 (95% CI, 94.38-100.82). In the analysis of the ratio of cystatin C levels more than 1.0 mg / l and the development of PE, a sensitivity of 98.46%, specificity of 100% and accuracy of 98.9%, p<0.001.

The data show that the combined model of maternal factors, ultrasound of the placenta and serum cystatin C, is prognostically effective in pregnant women in the second and third trimesters of gestation and is a reliable marker for the development of pe.

Bibbins-Domingo K. Screening for preeclampsia US preventive services task force recommendation statement. JAMA. 2017;317(16):1661-7. https://doi.org/10.1001/jama.2... PMid:28444286.
NICE. Hypertension in pregnancy: Diagnosis and management. National Institute for Health and Care Excellence; 2019. Available at: www.nice.org.uk/guidance/ng133 (Accessed: 21 September 2020).
American Diabetes Association. Management of diabetes in pregnancy: Standards of medical care in diabetes-2019. Care. 2019;42(Suppl1):165-72. https://doi.org/10.2337/dc19-S... PMid:30559240.
Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72:24-43. https://doi.org/10.1161/HYPERT... PMid:29899139.
Poon LC, Shennan A, Hyett JA, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol. 2019;145(1):1-33. https://doi.org/10.1002/ijgo.1... PMid:31111484 PMCid:PMC6944283.
Poon LC, Rolnik DL, Tan MY, et al. ASPRE trial: Incidence of preterm preeclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm. Ultrasound Obstet Gynecol. 2018;51:738-42. https://doi.org/10.1002/uog.19... PMid:29380918.
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 222 summary: Gestational hypertension and preeclampsia. Obstet Gynecol. 2020;135(6):237-60. https://doi.org/10.1097/AOG.00... PMid:32443079.
Giles LA. Implementing screening guidelines for preeclampsia prevention in a birth center: A quality improvement project. J Perinat Neonatal Nurs. 2020;34(4):324-9. https://doi.org/10.1097/JPN.00... PMid:32804877.
Guy GP, Leslie K, Diaz-Gomez D, et al. Implementation of routine first trimester combined screening for pre-eclampsia: A clinical effectiveness study. BJOG. 2021;128(2):149-56. https://doi.org/10.1111/1471-0... PMid:32613730.
FIGO. International Federation of Gynecology and Obstetrics; 2022. Available at: https://www.figo.org/figo-rele... (Accessed: 12 September 2022).
Shlipak MG, Tummalapalli SL, Boulware LE, et al. The case for early identi fi cation and intervention of chronic kidney disease: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2021;99:34-47. https://doi.org/10.1016/j.kint... PMid:33127436.
Bellos I, Fitrou G, Daskalakis G, Papantoniou N, Pergialotis V. Serum cystatin-C as a predictive factor of preeclampsia: a meta-analysis of 27 observational studies. Pregnancy Hypertens. 2019;16:97-104. https://doi.org/10.1016/j.preg... PMid:31056166.
Szczepanski J, Griffin A, Novotny S, Wallace K. Acute kidney injury in pregnancies complicated with pre-eclampsia or HELLP syndrome. Front Med. 2022;7:22. https://doi.org/10.3389/fmed.2... PMid:32118007 PMCid:PMC7020199.
Vijayalakshmi P, Usha SMR. Assessment of serum cystatin C and creatinine in monitoring pre-eclampsia. JCDR. 2019; 13(6):12-5. https://doi.org/10.7860/JCDR/2....
Digambarrao DJ, Pramod WI, Varsha BH. Cystatin C in preeclampsia: A case control study Int J Curr Res. 2015; 7(7):18226-30.
Kreepala C, Srila-on A, Kitporntheranunt M, Anakkamatee W, Lawtongkum P, Wattanavaekin P. The association between GFR evaluated by serum cystatin C and proteinuria during pregnancy. Kidney Int Rep. 2019;4:854-63. https://doi.org/10.1016/j.ekir... PMid:31194092 PMCid:PMC6551540.
Ebert N, Shlipak MG. Cystatin C is ready for clinical use. Curr Opin Nephrol Hypertens. 2020;29:591-8. https://doi.org/10.1097/MNH.00... PMid:32868529.
Popkov VA, Andrianova NV, Manskikh VN, et al. Pregnancy protects the kidney from acute ischemic injury. Sci Rep. 2018;8:14534. https://doi.org/10.1038/s41598... PMid:30266919 PMCid:PMC6162317.
Conti-Ramsden FI, Nathan HL, De greeff A, et al. Pregnancy-related acute kidney injury in preeclampsia. Hypertension. 2019;74(5):1144-51. https://doi.org/10.1161/HYPERT... PMid:31564161 PMCid:PMC6791560.
Park S, Lee SM, Park JS, et al. Midterm eGFR and adverse pregnancy outcomes: The clinical significance of gestational hyperfiltration. Clin J Am Soc Nephrol. 2017;12:1048-56. https://doi.org/10.2215/CJN.12... PMid:28611078 PMCid:PMC5498359.
KDIGO. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. KI. 2021;100:1-276.
Wattanavaekin K, Kitporntheranunt M, Kreepala C. Cystatin C as a novel predictor of preterm labor in severe preeclampsia. Kidney Res Clin Pract. 2018;37(4):338-46. https://doi.org/10.23876/j.krc... PMid:30619689 PMCid:PMC6312773.
Kozlov SV, Dvoretskyi DD, Alekseenko LA, Omelchenko A, Kartamыsheva VD. Variant anatomy of the uterine arteries. UWMBS. 2018;3-4(13):32-7. https://doi.org/10.26693/jmbs0....
Priyadarshini A, Upreti P, Nautiyal R, Goyal M. Placental location and development of preeclampsia: A longitudinal study. Int J Reprod Contracept Obstet Gynecol. 2019;8(4):1283-7. https://doi.org/10.18203/2320-....
Kumari N, Dash K, Singh R. Relationship between maternal age and preeclampsia. IOSR-JDMS. 2016;15(12):55-7.
Quan LM, Xu QL, Zhang GQ, Wu LL, Xu H. An analysis of the risk factors of preeclampsia and prediction based on combined biochemical indexes. Kaohsiung J Med Sci. 2018;34:109-12. https://doi.org/10.1016/j.kjms... PMid:29413226.
Walker KF, Thornton JG. Advanced maternal age. Obstet Gynaecol Reprod Med. 2016;26:354-7. https://doi.org/10.1016/j.ogrm....
Ndiaye MD, Guèye M, Diallo M, et al. The impact of extreme maternal ages on hypertensive disorders of pregnancy: A retrospective cohort study in Dakar, Senegal. OJOG. 2020;10:213-20.https://doi.org/10.4236/ojog.2....
Habek C, Bobik MV, Habek D, Gulin D, Gulin S. Pregestational obesity–risk factor for preeclampsia. Med Jad. 2019;49(1):45-9.
Poorolajal J, Jenabi E. The association between body mass index and preeclampsia: A meta-analysis. J Matern Fetal Neonatal Med. 2016;29(22):3670-6. https://doi.org/10.3109/147670... PMid:26762770.
Hussain W, Khan HA, Imran M. Obesity: A risk factor of preeclampsia. Int J Front Sci. 2019;3(2):104-7. https://doi.org/10.37978/tijfs....
Chen C-N, Chen HS, Hsu HC. Maternal prepregnancy body mass index, gestational weight gain, and risk of adverse perinatal outcomes in Taiwan: A population-based birth cohort study. Int J Environ Res Public Health. 2020;17(4):1221. https://doi.org/10.3390/ijerph... PMid:32074959 PMCid:PMC7068269.
Lee Y, Magnus P. Maternal and paternal height and the risk of preeclampsia. Hypertension. 2018;71:666-70. https://doi.org/10.1161/HYPERT... PMid:29463626.
Berlinska LI, Marichereda VG, Holubenko MY, Pavlovska OM. Maternal factors of pre-eclampsia development. RE. 2021;2(59):102-6. https://doi.org/10.18370/2309-....
Nair VV, Nair SS, Radhamany K. Study of placental location and pregnancy outcome. Int J Reprod Contracept Obstet Gynecol. 2019;8(4):1393-7. https://doi.org/10.18203/2320-....
Prathima A, Reddi Rani P. Association of placental position with the development of hypertension in pregnancy. Int J Reprod Contracept Obstet Gynecol. 2018;8(1):238-42. https://doi.org/10.18203/2320-....
Keshavarz E, Sadeghian A, Hakemi AG, Khtibi FT. Prediction of pre-eclampsia development by placenta location: A simple predictor. J ObstetGynecol Cancer Res. 2017;2(4):e11945. https://doi.org/10.5812/jogcr.....
Rai A, Thatal A, Sharma BK, Narwat Y. Lateral placenta as a predictor for the development of preeclampsia. IJOGR. 2020;7(2):216-21. https://doi.org/10.18231/j.ijo....
Salama-Bello R, Duncan JR, Howard SL, Song J, Schenone MH. Placental location and the development of hypertensive disorders of pregnancy. J Ultrasound Med. 2019;38:173-7. https://doi.org/10.1002/jum.14... PMid:29732593.
Navolotskaya VK, Lyashko ES, Shifman EM, et al. Possibilities for prediction of preeclampsia complications. Russ J Hum Reprod. 2019;25(1):20-9. https://doi.org/10.17116/repro....
Sani HM, Vahed SZ, Ardalan M. Preeclampsia: A close look at renal dysfunction. Biomed Pharmacother. 2019;109:408-16. https://doi.org/10.1016/j.biop... PMid:30399576.
Marichereda VH, Holubenko MIu, Berlinska LI. Priority of cystatin C among renal biomarkers in the diagnosis of preeclampsia. Kidneys. 2020;9(2):87-91. https://doi.org/10.22141/2307-....
Napryeyenko O, Napryeyenko N, Marazziti D, et al. Depressive syndromes associated with alcohol dependence. Clin Neuropsychiatry. 2019;16(5-6):206-12.
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