Preeclampsia prediction and prophylaxis in routine first-trimester screening services

Abstract

Prenatal screening confers benefits to the population served by that program. Screening programs that are poorly implemented can also be harmful. This article proposes the practical means to establish a routine clinical service of first-trimester prediction for preterm preeclampsia. A combination of maternal characteristics, mean arterial pressure, uterine artery Doppler, and placental growth factor can identify the majority of preterm (<37 weeks of gestation) preeclampsia with reasonably low false-positive rate. A single visit to an integrated clinic at 11–13 weeks’ gestation also allows for an assessment of the risks for a wider range of pregnancy complications, including common fetal aneuploidies and early-onset fetal growth restriction. Certification and audit of ultrasound operators and laboratories is important to assure the quality of the prenatal screening service. In the context of preeclampsia, the primary aim of such clinic is to identify those that would potentially benefit from prophylactic intervention with aspirin to improve placentation.