External validity of first-trimester algorithms in the prediction of pre-eclampsia disease severity

N. Oliveira, L. E. Doyle, R. O. Atlas, C. B. Jenkins, M. G. Blitzer, Ahmet Baschat

Research output: Contribution to journalArticle

Abstract

Objective To compare disease features in women with pre-eclampsia between those who are correctly identified (true positive) and those who are missed (false negative) when applying first-trimester prediction algorithms for pre-eclampsia to a prospectively enrolled population. Method Six first-trimester early (requiring delivery <34 weeks' gestation) pre-eclampsia algorithms were applied to a prospective cohort of singleton pregnancies enrolled at first-trimester screening. Maternal outcomes, neonatal outcomes and severity parameters for pre-eclampsia were compared between true-positive and false-negative predictions. Results Twenty of 2446 (0.8%) women developed early pre-eclampsia, with 65% of these developing severe features and 20% HELLP syndrome. At enrollment, true-positive cases were more likely to be African-American and chronically hypertensive, while false-negative cases were more likely to be Caucasian. At delivery, true-positive cases were more likely to have pre-eclampsia superimposed on hypertension, severely elevated blood pressure and creatinine level > 1.1 mg/dL. False-negative cases were more likely to have HELLP syndrome (all P <0.05). Conclusion In an urban population with a high prevalence of chronic hypertension, patients who are correctly identified by first-trimester screening models are more likely to develop pre-eclampsia superimposed on chronic hypertension with severely elevated blood pressure and evidence of renal failure. In contrast, patients who are missed by these algorithms are more likely to have HELLP syndrome. Further research is needed to confirm these findings and the algorithm adjustments that may be necessary to better predict pre-eclampsia phenotypes.

Original languageEnglish (US)
Pages (from-to)286-292
Number of pages7
JournalUltrasound in Obstetrics and Gynecology
Volume44
Issue number3
DOIs
StatePublished - 2014

Fingerprint

First Pregnancy Trimester
Pre-Eclampsia
HELLP Syndrome
Hypertension
Urban Population
Renal Insufficiency
Blood Pressure
Phenotype
Research
Population

Keywords

  • first-trimester pre-eclampsia screening
  • HELLP syndrome
  • maternal outcomes
  • neonatal outcomes
  • severe pre-eclampsia

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Reproductive Medicine
  • Medicine(all)

Cite this

External validity of first-trimester algorithms in the prediction of pre-eclampsia disease severity. / Oliveira, N.; Doyle, L. E.; Atlas, R. O.; Jenkins, C. B.; Blitzer, M. G.; Baschat, Ahmet.

In: Ultrasound in Obstetrics and Gynecology, Vol. 44, No. 3, 2014, p. 286-292.

Research output: Contribution to journalArticle

Oliveira, N. ; Doyle, L. E. ; Atlas, R. O. ; Jenkins, C. B. ; Blitzer, M. G. ; Baschat, Ahmet. / External validity of first-trimester algorithms in the prediction of pre-eclampsia disease severity. In: Ultrasound in Obstetrics and Gynecology. 2014 ; Vol. 44, No. 3. pp. 286-292.
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