Prediction of mild and severe preeclampsia with blood pressure measurements in first and second trimester of pregnancy (original) (raw)
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The study was designed to determine the accuracy of using systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), and increase of blood pressure (BP) to predict Preeclampsia (PE). Materials and Methods: We examined 300 normotensive and 100 PE pregnancies divided in two subgroups: mild (n=67) and severe (n=33) PE. The patients had a BP check in first and second trimester (SBP, DBP, and MAP). Results: We found out significant difference between the groups, but what is more important is that the difference in BP values (especially diastolic and MAP) existed before the pathological increase of the BP above the normal values. This was happening most often after 31 wg (at 92.5%) and less often after 26 wg (at 7.5%) at the pregnancies with mild PE while at the pregnancies with severe PE, 18,2% had increased tension after 21 wg; 24% in the period of 26-30 wg and 57.58% after 31 wg. Conclusion: Based on the results we could conclude that when BP is measured in the first or second trimester of pregnancy, the MAP is a better predictor for PE than SBP and DBP.
Journal of Babol University of Medical Sciences, 2020
BACKGROUND AND OBJECTIVE: Preeclampsia is a common disease during pregnancy that may be associated with maternal and fetal mortality. Since the pathogenic process of preeclampsia begins during the first trimester of pregnancy, it is very difficult to identify biomarkers of early detection of preeclampsia. The aim of this study was to determine the predictive validity of systolic, diastolic and mean arterial blood pressure in the first trimester of pregnancy in the diagnosis of preeclampsia. METHODS: This case-control study was performed on 200 pregnant women referred to Ayatollah Rouhani Hospital in Babol within a historical cohort. The data of the records of 100 pregnant women with preeclampsia diagnosis (case group) and 100 healthy women (control group) were filled in special forms and compared. FINDINGS: According to ROC curve analysis, in the first trimester for systolic blood pressure at the cut-off point of 117.5, sensitivity of 56% and specificity of 70%, for diastolic blood pressure at the cut-off point of 72.5, sensitivity of 68% and specificity of 63% and for mean arterial pressure at the cut-off point of 87.5, sensitivity of 67% and specificity of 66% were calculated. Based on the area under the ROC curve, the diagnostic power was 0.706, 0.663 and 0.709, respectively (p<0.001). CONCLUSION: The results of the present study indicate that arterial pressure can be used as an effective method in identifying women at risk for preeclampsia as a selection criterion in testing, treatment or prevention.
A prospective study of blood pressure in pregnancy: Prediction of preeclampsia
American Journal of Obstetrics and Gynecology, 1985
A prospective study of blood pressure recording was conducted in 1 000 patients, at each antenatal visit, with the use of an automatic random-zero sphygmomanometer. In 46 patients, among 808 primigravid women, who developed preeclampsia, the diastolic and mean blood pressures were significantly elevated compared to values at the first antenatal visit (p < 0.01, 9 to 12 weeks). This difference was sustained throughout pregnancy until delivery by at least 1 0 mm Hg as compared to pressures in the normotensive group. Sensitivity for predicting preeclampsia early in pregnancy with an elevated blood pressure measurement (130 to 1.35/80 to 85 mm Hg) ranged from 16% to 57% while specificity ranged from 75% to 98%. The results substantiate an early vasospasm (9 to 12 weeks) in those women destined to develop preeclampsia.
The Professional Medical Journal, 2021
Objective: To assess the diagnostic accuracy of mean arterial pressure in second trimester for prediction of pre-eclampsia in females. Study Design: Cross-sectional study. Setting: Department of Obstetrics & Gynecology Unit III, Allied hospital, Faisalabad. Period: October 2016 to September 2017. Material & Methods: Total 386 patients were enrolled after obtaining informed consent. Booked females of age 18-40 years, parity<5 presenting at gestational age >16 weeks (on LMP) for antenatal checkup were included in study. Patients with multiple gestation (on medical record and USG), Females with chronic hypertension (BP≥140/90mmHg), chronic or gestational diabetes (BSR>186mg/dl), Females having oligohydramnios (AFI<5cm) or polyhydramnios (AFI>21cm) on USG, females having abnormal placental implantation or placental abruption (on USG) were excluded. The mean age of the patients was 28.59±6.93 years. The MAP of the patients was 94.88±14.68 mmHg. Results: The sensitivity, sp...
Journal of perinatal medicine, 2017
To propose a simple model for predicting preeclampsia (PE) in the 1st trimester of pregnancy on the basis of maternal characteristics (MC) and mean arterial pressure (MAP). A prospective cohort was performed to predict PE between 11 and 13+6 weeks of gestation. The MC evaluated were maternal age, skin color, parity, previous PE, smoking, family history of PE, hypertension, diabetes mellitus and body mass index (BMI). Mean arterial blood pressure (MAP) was measured at the time of the 1st trimester ultrasound. The outcome measures were the incidences of total PE, preterm PE (delivery <37 weeks) and term PE (delivery ≥37 weeks). We performed logistic regression analysis to determine which factors made significant contributions for the prediction of the three outcomes. We analyzed 733 pregnant women; 55 developed PE, 21 of those developed preterm PE and 34 term PE. For total PE, the best model was MC+MAP, which had an area under the receiver operating characteristic curve (AUC ROC) o...
Journal of South Asian Federation of Obstetrics and Gynaecology, 2021
Background: Reliable markers for the prediction of pre-eclampsia (PE) and reducing its associated maternal and perinatal morbidity are lacking. Aims and objectives: To evaluate the role of mean arterial pressure (MAP) in the second trimester of pregnancy for predicting gestational hypertension (GH) and PE. Materials and Methods: Three-hundred and sixteen healthy and normotensive women were enrolled in the second trimester of pregnancy. The mean MAP for the woman was recorded as an average of two MAPs at 3-4 week intervals during the second trimester of pregnancy. All women were followed till term/delivery to predict the development of GH and pre-eclampsia later. Results: The performance of MAP for predicting the GH and PE was found to be very good. The area under the receiver operating characteristic (AUROC) for GH was 0.892 with sensitivity and specificity of 84.2 and 84.9%, respectively, whereas the AUROC for PE was 0.948 with sensitivity and specificity of 83.3 and 84.9%, respectively. Conclusion: MAP in the second trimester of pregnancy can be used to triage women with low-risk pregnancy for pregnancy hypertension. Clinical significance: Mid-trimester MAP is a very good parameter for the prediction of GH and PE. It should be routinely used for risk triaging in low-risk women for the development of hypertension in pregnancy.
Prediction of Preeclampsia by Mean Arterial Pressure at 11-13 and 20-24 Weeks' Gestation
Fetal Diagnosis and Therapy, 2014
Objectives: To assess the performance of screening for preeclampsia (PE) by mean arterial pressure (MAP) at 11-13 and at 20-24 weeks' gestation. Methods: MAP was measured at 11-13 and 20-24 weeks in 17,383 singleton pregnancies, including 70 with early PE, requiring delivery <34 weeks' gestation, 143 with preterm PE, delivering <37 weeks and 537 with total PE. MAP was expressed as multiple of the median (MoM) after adjustment for maternal characteristics and corrected for adverse pregnancy outcomes. The performance of screening for PE by maternal characteristics and MAP MoM at 11-13 weeks (MAP-1), MAP MoM at 20-24 weeks (MAP-2) and their combination was evaluated. Results: In screening by maternal characteristics and MAP-1, at a false-positive rate (FPR) of 10%, the detection rates (DR) of early PE, preterm PE and total PE were 74.3, 62.9 and 49.3%, respectively; the DR at FPR of 5% were 52.9, 42.7 and 35.8%. In screening by MAP-1 and MAP-2 the DR at FPR of 10%, were 8...
Nigerian Journal of Clinical Practice, 2017
Background: Early detection of preeclampsia will help reduce the morbidities and mortalities associated with the disorder. Late-onset preeclampsia was the predominant presentation in this cohort. The search for biomarkers for predicting preeclampsia is still ongoing. Mean arterial blood pressure (MABP), which has the advantage of presenting a single cutoff value compared with the use of systolic and diastolic blood pressure measurements, merits evaluation. Aim: The study aims to evaluate the clinical utility of second trimester MABP in the prediction of preeclampsia. Methods: This was a prospective cohort study of 155 normotensive, nonproteinuric pregnant women without prior history of gestational hypertension. The women were booked patients attending the antenatal clinic at the Lagos University Teaching Hospital and were all in their second trimesters of pregnancy. The outcome measures were systolic blood pressure, diastolic blood pressure, and MABP. The end point of the study was the development of preeclampsia. The diagnosis of preeclampsia was made by the attending obstetrician. The data were analyzed using the IBM SPSS statistical software. Statistical significance was set at P < 0.05. Results: One hundred and fifty-five pregnant women participated in the study. Eleven (7.1%) of the women developed preeclampsia after 34 weeks gestation and 144 (92.9%) had normal pregnancy. The mean gestational age at the time of assessment was 18.88 ± 3.15 weeks with a range of 14 weeks to 27 completed weeks. There was a statistically significant increase in the systolic blood pressure, diastolic blood pressure, and MABP values in the group of women who later developed preeclampsia, P = 0.005, 0.001, and <0.001, respectively. At a false-positive rate of 10%, MABP value of 88.33 mmHg predicted preeclampsia with a specificity of 90% and a sensitivity of 45.5%, P <0.05. The area under the receiver-operative characteristics curve (AUC) was 0.732 (95% confidence interval, 0.544-0.919, P = 0.011). The negative predictive value (NPV) was 88.88% and the positive predictive value (PPV) was 45.45%, P < 0.05. At an MABP cutoff of 88.33 mmHg, preeclampsia was predicted with a relative risk of 4.44 and a positive likelihood ratio of 6.46, P < 0.05. Conclusions: With an AUC of 0.732, MABP performed moderately (considering that excellent performance has an AUC of 1.0) in the prediction of late-onset preeclampsia in Nigerian women. Its high NPV suggests a strong ability to rule out preeclampsia and help to appropriate management.
Mean Arterial Pressure at 11+0 to 13+6 Weeks in the Prediction of Preeclampsia
Hypertension, 2008
This study aimed to determine the performance of screening for preeclampsia (PE) by maternal medical history and mean arterial pressure (MAP) at 11 ϩ0 to 13 ϩ6 weeks. In 5590 women with singleton pregnancies attending for routine care at 11 ϩ0 to 13 ϩ6 week's gestation we recorded maternal variables and measured the MAP. We excluded 397 because they had missing outcome data or the pregnancies resulted in miscarriage or termination. In 104 patients there was subsequent development of PE, 97 developed gestational hypertension, 574 delivered small-for-gestational-age newborns, and 4418 were unaffected by PE, gestational hypertension, or small for gestational age. A multivariate Gaussian model was fitted to the distribution of log multiple of the median MAP in the PE and unaffected groups. Likelihood ratios for log multiple of the median MAP were computed and used together with maternal variables to produce patient-specific risks for each case. Detection rates and false-positive rates were calculated by taking the proportions with risks above a given risk threshold. In the unaffected group, log MAP was influenced by maternal age, ethnic origin, smoking, family and personal history of PE, and fetal crown-rump length. In the prediction of PE, significant contributions were provided by log multiple of the median MAP, ethnic origin, body mass index, and personal history of PE. The detection rate of PE by log multiple of the median MAP and maternal variables was 62.5% for a false-positive rate of 10%. Maternal variables, together with MAP, at 11 ϩ0 to 13 ϩ6 weeks identify a group at high risk for development of PE. (Hypertension. 2008;51:1027-1033.)