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      The role of maternal serumbeta-HCG and PAPP-A levels at gestational weeks 10 to 14 in the prediction of pre-eclampsia

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          Abstract

          Objective: We aimed to detect whether maternal serum free β-hCG and PAPP-A levels and NT measurements vary between normal pregnancies and those that subsequently develop pre-eclampsia and to evaluate the role of these screening serum analytes in the prediction of pre-eclampsia.

          Methods: Using a case-control study design, we identified all women who had been screened by double test within 11+0 and 13+6 weeks of gestation and who had developed pre-eclampsia during the subsequent pregnancy course, over a 6-year period between January 2006 and December 2012 at two tertiary referral hospital. All women who had undergone a double test during that time, without a diagnosis of pre-eclampsia and who had not had any adverse obstetric outcomes, were also identified, and three women among them were randomly selected as controls for each case. Maternal and neonatal data were abstracted from the medical records and PAPP-A, β-hCG, NT and CRL MoM values were compared between the two groups.

          Results: Although β-hCG values show no statistically significant difference (p=0.882), PAPP-A levels were significantly reduced in the pre-eclampsia group compared to the control group (p<0.001). NT and CRL values showed no significant difference between the two groups (p=0.674 and p=0.558, respectively).

          Conclusion: Measuring PAPP-A in the first trimester may be useful in the prediction of pre-eclampsia.

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          Most cited references20

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          ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002.

          (2002)
          Hypertensive disease occurs in approximately 12-22% of pregnancies, and it is directly responsible for 17.6% of maternal deaths in the United States (1,2). However, there is confusion about the terminology and classification of these disorders. This bulletin will provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy (ie, preeclampsia and eclampsia), as well as the various associated complications. Chronic hypertension has been discussed elsewhere (3).
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            First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial).

            The purpose of this study was to determine whether maternal serum levels of pregnancy-associated plasma protein A, free-beta subunit human chorionic gonadotropin, or nuchal translucency size are associated with obstetric complications. Data were obtained from the First and Second Trimester Evaluation of Risk trial. Pregnancy-associated plasma protein A and free-beta subunit human chorionic gonadotropin levels were analyzed, and nuchal translucency was measured between 10 weeks 3 days and 13 weeks 6 days of gestation in 34,271 pregnancies. Women with pregnancy-associated plasma protein A of or =99th percentile and free-beta subunit human chorionic gonadotropin at < or =1st percentile were associated with an increased risk of spontaneous loss at < or =24 weeks of gestation (adjusted odds ratios, 3.90, 3.62, respectively; P < .001). Low pregnancy-associated plasma protein A levels in the first trimester were associated strongly with a number of adverse pregnancy outcomes. Low free-beta subunit human chorionic gonadotropin levels and large nuchal translucency were both associated with early fetal loss.
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              World Health Organization systematic review of screening tests for preeclampsia.

              We sought to assess the usefulness of clinical, biophysical, and biochemical tests in the prediction of preeclampsia. The sources of data we used to conduct this review included the computerized databases MEDLINE (1966 to February 2003), EMBASE, Popline, CINAHL, and LILACS plus reference lists, conference proceedings, textbooks, and contact with experts. All cohort or cross-sectional studies reporting data on the relationship between a predictive test that was performed during pregnancy and the development of preeclampsia were eligible for inclusion, whereas case-control studies were excluded. Eighty-seven (211,369 women) of 7,191 potentially relevant articles met inclusion criteria. We evaluated the methodologic quality for each included study. Using a standardized protocol, one reviewer selected and extracted data on study characteristics, quality, and accuracy. Data abstracted from each study were arranged in 2 x 2 tables to construct receiver operating characteristics plots (sensitivity against 1 - specificity) and pooled to produce summary likelihood ratios for positive and negative tests results. Moderate predictive accuracy of anticardiolipin antibodies, the presence of bilateral diastolic notches during Doppler ultrasonography, and urinary kallikrein were found in women at low risk of developing preeclampsia. Nevertheless, because the pretest probability of preeclampsia with a positive result was but minimally increased, the clinical use of these tests is limited. Other ultrasonography characteristics and the measurement of fetal and placental peptides showed low predictive accuracy. In populations that were deemed at high risk for preeclampsia, the use of Doppler ultrasonography had low predictive accuracy. No definitive conclusions were possible in the case of many other tests, because the number of studies that met the minimal inclusion criteria was limited. As of 2004, there is no clinically useful screening test to predict the development of preeclampsia. Further prospective, longitudinal studies are needed.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                PJMS
                Pakistan Journal of Medical Sciences
                Professional Medical Publicaitons (Karachi, Pakistan )
                1682-024X
                1681-715X
                May-Jun 2014
                : 30
                : 3
                : 568-573
                Affiliations
                [1 ]Ozkan Ozdamar, Department of Obstetrics and Gynecology, Golcuk Military Hospital, Golcuk, Kocaeli, Turkey.
                [2 ]Ismet Gun, Associate Professor, Department of Obstetrics and Gynecology,GATA Haydarpasa Training Hospital, Istanbul, Turkey.
                [3 ]Ugur Keskin, Assistant Professor, Department of Obstetrics and Gynecology, GATA Medical Faculty, Ankara, Turkey.
                [4 ]Necmettin Kocak, MD, Department of Public Health, GATA Medical Faculty, Ankara, Turkey.
                [5 ]Ercument Mungen, Professor, Department of Obstetrics and Gynecology,GATA Haydarpasa Training Hospital, Istanbul, Turkey.
                Author notes
                Correspondence: Ozkan Ozdamar, Department of Obstetrics & Gynecology, Golcuk Military Hospital, 41650, Golcuk, Kocaeli, Turkey. E-mail: ozkan_ozdamar35@hotmail.com
                Article
                10.12669/pjms.303.4554
                4048508
                87dc101b-399a-4f78-9ca2-ee9261154696

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 October 2013
                : 1 February 2014
                : 6 February 2014
                Categories
                Original Article

                papp-a,β-hcg,first trimester,pre-eclampsia.
                papp-a, β-hcg, first trimester, pre-eclampsia.

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