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Type: Journal article
Title: Screening for Placental Insufficiency in High-risk Pregnancies: Is Earlier Better?
Author: Costa, S.
Proctor, L.
Dodd, J.
Toal, M.
Okun, N.
Johnson, J.
Windrim, R.
Kingdom, J.
Citation: Placenta, 2008; 29(12):1034-1040
Publisher: W B Saunders Co Ltd
Issue Date: 2008
ISSN: 0143-4004
Statement of
S.L. Costa, L. Proctor, J.M. Dodd, M. Toal, N. Okun, J.-A. Johnson, R. Windrim and J.C.P. Kingdom
Abstract: OBJECTIVE: To compare a profile of placental function between the first and second trimesters in pregnancies at high risk of adverse perinatal outcomes attributable to placental insufficiency. STUDY DESIGN: Prospective cohort study in 61 singleton pregnancies. Uterine artery Doppler and placental morphology (shape and texture) were determined at 11-13(+6) weeks and at 18-23(+6) weeks. First trimester (pregnancy-associated placental protein-A [PAPP-A]) and second trimester (total hCG and alpha fetoprotein [AFP]) serum biochemistry were determined. The two screening periods were compared for the prediction of a range of severe adverse perinatal outcomes (intrauterine growth restriction [IUGR], abruption, severe pre-eclampsia/HELLP syndrome, delivery<32 weeks, or stillbirth). RESULTS: Adverse perinatal outcomes occurred in 14 (23%) women; 3 (4.9%) losses<20 weeks, 2 (3.3%) stillbirths>20 weeks, 4 (6.6%) IUGR, 7 (11.5%) severe pre-eclampsia/HELLP syndrome, and 10 (16.4%) deliveries<32 weeks. Abnormal second trimester placental morphology was significantly associated with adverse outcome [+LR: 3.6, 95% CI: 1.3-8.5; -LR: 0.63, 95% CI: 0.36-0.93; p=0.025], as was > or = 1 abnormal second trimester tests [+LR: 5.9, 95% CI: 1.6-24; -LR: 0.68, 95% CI: 0.59-0.89; p=0.005] or > or = 2 abnormal second trimester tests [+LR: 3.6, 95% CI: 1.3-7.7; -LR: 0.58, 95% CI: 0.27-0.94; p=0.035]. No combination of first trimester tests significantly predicted severe adverse perinatal outcomes. A study sample size of 822 women with similar high-risk characteristics would be needed in order to refute the conclusion that present methods of first trimester screening are not inferior to second trimester screening for severe placental insufficiency (p=0.05, power 80%, z-test). CONCLUSIONS: In clinically high-risk pregnancies, prediction of adverse perinatal outcomes using placental function testing is more effective in the second compared with the first trimester.
Keywords: Maternal serum screening; First and second trimesters; Uterine artery Doppler; Placental morphology; Adverse perinatal outcome; Placental pathology
RMID: 0020083908
DOI: 10.1016/j.placenta.2008.09.004
Appears in Collections:Obstetrics and Gynaecology publications

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