cribratge de preeclàmpsia... hofmeyr g, cochrane database syst rev 2006 askie lm, lancet 2007...
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Cribratge de preeclàmpsia
Sessió de Formació Continuada
ACMCB
Maig 2014
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Decisions que has de pendre abans
abans de fer un programa d´screening
• Perquè vols cribar
• Quin % de gestants vols considerar en risc
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Hofmeyr G, Cochrane Database Syst Rev 2006 Askie LM, Lancet 2007 Bujold E Obstet Gynecol. 2010
Calcium (in high risk population with low calcium intake 1gr/24h)
Antioxidants (no reduction and even increased complications)
Aspirin (75-300 mg/d): overall risk reduction
10%
Physiopathology There is prophylactic treatment?
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Hofmeyr G, Cochrane Database Syst Rev 2006 Askie LM, Lancet 2007 Bujold E Obstet Gynecol. 2010
Calcium (in high risk population with low calcium intake 1gr/24h)
Antioxidants (no reduction and even increased complications)
Aspirin (75-300 mg/d): overall risk reduction
before 16 weeks
10%
47%
Physiopathology There is prophylactic treatment?
www.medicinafetalbarcelona.org/
Hofmeyr G, Cochrane Database Syst Rev 2006 Askie LM, Lancet 2007 Bujold E Obstet Gynecol. 2010
Calcium (in high risk population with low calcium intake 1gr/24h)
Antioxidants (no reduction and even increased complications)
Aspirin (75-300 mg/d): overall risk reduction
before 16 weeks in high-risk women
10%
47%
60%
Physiopathology There is prophylactic treatment?
www.medicinafetalbarcelona.org/
Hofmeyr G, Cochrane Database Syst Rev 2006 Askie LM, Lancet 2007 Bujold E Obstet Gynecol. 2010
Calcium (in high risk population with low calcium intake 1gr/24h)
Antioxidants (no reduction and even increased complications)
Aspirin (75-300 mg/d): overall risk reduction
before 16 weeks in high-risk women early onset PE 80%
10%
47%
60%
Physiopathology There is prophylactic treatment?
www.medicinafetalbarcelona.org/
Duckitt K, Harrington D. Risk factors for preeclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005; 330:565
• Previous PE / antiphospholipid syndrome x8
• BMI 35 kg/m2 / Diabetes x4
• Nuliparity/ Multiples /Familiar history x3
• Age 40 y., Hypertension , renal or autoimmune disease, interpregnancy interval >10y x2
Epidemiological risk ¿What is risk?
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Cohort 2009-2013
• N=9462
– PE precoç 57 (0.6%)
– PE tardana 246 (2.6)
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TD: 45%-60% (per FP 5%-20%)
Factors epidemiològics
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1+ Major criteria Renal disease Autoimmune disease Diabetes Mellitus Chronic hypertension Previous preeclampsia 2+ Minor criteria Primiparity Multiple gestation Interpregnancy interval> 10 y Maternal age >40 y Familiar history of preeclampsia BMI > 35 kg/m²
NICE clinical guideline 107 August 2010
Epidemiological risk
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6-12 w
16-24 w
Before pregnancy
Uterine Doppler ¿What is risk?
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AAS Control OR (IC 95%)
Vanio 2/43 10/43 Ebrashy 26/74 40/65
Total (95% CI) 0.22 [0.08, 0.57]
0.1 0.2 0.5 1 2 5 10
Screening Uterine Doppler: aspirin
August 3/48 5/50
Villa 8/61 11/60
11-14 w PE
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Van den Elzen 95, Martin 01, Vainio 05, Ebrashy 05, Gómez 05, Parra 05, Plasencia 07
Limited detection rate Allows prophylactic intervention?
Detection rate for 10% FPR
PE ~25%
Early PE ~50%
11-14 w
Screening Uterine Doppler
PE
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TD: 65%-85% (per FP 5%-20%)
Factors epidemiològics
Doppler uterina
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• Cardiac output • Brain hemodynamic • Pulse wave analysis
• Blood pressure
Detection rate (10% FP)
Early PE ~50%
Maternal hemodynamic Screening
Poon LC,. Hypertensive disorders in pregnancy: screening by systolic diastolic and mean arterial pressure at 11-13 weeks. Hypertens Pregnancy. 2010;30(1):93-107
11-14 w PE
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TD: 75%-85% (per FP 5%-20%)
Factors epidemiològics
Doppler uterina
Tensió arteria
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Screening
11-14 w PE
PlGF
sFlt
Perfil angiogénico
Perfil anti-angiogénico
Marcadores Bioquímicos
PlGF
sFlt
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Early PE ~40%
Angionenic factors
Late PE ~30%
Detection rate (10% FP)
Wortelboer EJ, BJOG 2010; Audibert F AJOG 2010; Akelokar R Prenat Diagn 2011; ; ;;
Biochemical markers Screening
11-14 w PE
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TD: 80%-95% (per FP 5%-20%)
Factors epidemiològics
Doppler uterina
Tensió arteria
PlGF
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https://www.google.es/?gfe_rd=cr&ei=lkZyU__iOozmjwfI2IGACw#q=calcul
adora+gestacional
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Detection rate (5% FP) >1/75 Early PE 71%
Combined tests Screening
0 20 40 60 80 100
FP
100
80
60
40
20
0
DR
Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting. Scazzocchio E AJOG 2012
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PREECLAMPSIA PRECOÇ
…… SFlt
PlGF
-·-·-·- Ratio
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Construction cohort
(n=5170)
Validation cohort
(n=4175)
% PE 0.5% 0.7%
5% FPR-DR 69% 75%
10% FPR-DR 81% 82%
AUC 0.95 0.92
R2 36.8% 42.3
Shrinkage 5.5% (<10% Snee RD, Technometrics 1974)
Early preeclampsia: validation
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Construction cohort
(n=5170)
Validation cohort
(n=4175)
% PE 2.6% 3.4%
5% FPR-DR 24% 75%
10% FPR-DR 37% 82%
AUC 0.71 0.72
R2 10.1% 8.4%
Shrinkage 1.7% (<10% Snee RD, Technometrics 1974)
Late preeclampsia: validation