The Clinical Significance Of Predicting Preeclampsia And Fetal Growth Restriction In Early And Mid-pregnancy Screening

purpose:Comparing the predictive value of early pregnancy,middle pregnancy and early-middle-pregnancy combined screening for preeclampsia(PE)and fetal growth restriction(FGR).Research objects and methods:We select to collect pregnant women from January 2010 to June 2015 at the First Affiliated Hospital of Jinan University and deliver pregnant women at the same time.During the pregnancy,two ultrasound examinations are performed in the fetal medicine department of the hospitalat at the same time.They are Down’s screening in early pregnancy(11-13+6 weeks)and systemic prenatal ultrasonography screening in the second trimester(20-24 weeks),finally,we select 101 eligible PE’s pregnant women,65 FGR’s pregnant women,and 3015 normal pregnant women.We record the clinical indicators of pregnant women,ultrasonic and serological indicators of early prenatal(11-13+6 weeks)screening and mid-pregnancy(20-24 weeks)system prenatal ultrasound screening.When the test level is a=0.05,Logistic regression analysis and receiver operating characteristic curve(ROC)are applied to evaluate gestational age indicators alone and to evaluate combined application of PE’s or FGR’s predictive value,we check sensitivity and specificity to identify a combination of the indexes at the optimal cut-off point and we find most predictive area under ROC curve.result:First,pre-eclampsia:(1)Early pregnancy screening:1.Individual index screening in early pregnancy:a false positive rate of 5%,the statistically significant predictors in the univariate analysis are the HDCP,chronic hypertension,and family history of preeclampsia.body mass index,MAP,BPD,PAPP-A.In the multivariate analysis,statistical differences between the PE group and the normal pregnancy group are HDCP history,number of delivery,MAP,PAPP-A;HDCP history and MAP is a risk factor for PE,HDCP history is the greatest risk factor;early MAP of AUC is 0.745(95%CI was 0.695-0.795),it is greater than the other single indicators.When MAP is 85.88 mmHg,the sensitivity is 59.4%and the specificity is 78.1%;the correlation between the number of delivery and HDCP history is the strongest.2.Multi-criteria screening in early pregnancy:The area under the curve of the number of delivery+HDCP history+MAP+PAPP-A is higher than the history of HDCP,the number of delivery,MAP,PAPP-A alone,the area under the curve is 0.767(95%CI0.718-0.816),when the incidence of the number of delivery+HDCP history+MAP+PAPP-A cutoff is 0.034,sensitivity is 68.3%,specificity is 74.8%.PE’s detection rate is 69/101(68.3%).(2)middle pregnancy screening:1.Individual index screening in middle pregnancy:a false positive rate is 5%,the statistically significant predictors in the univariate analysis are HDCP history,chronic hypertension history,PE history,FL,UTA-PI,and UTA-RI.Statistically significant was HDCP history,the number of delivery,history of chronic hypertension,BMI,UTA-PI in multivariate analysis;HDCP history,history of chronic hypertension,BMI,UTA-PI are risk factors for PE,HDCP history is the highest risk:UTA-PI has the largest area under the curve,and AUC of the number of delivery is the smallest;sensitivity is 42.6%,specificity is 80.6%.when UTA-PI≧1.105.when BMI≧19.713(kg/m~2).sensitivity is 71.3%,specificity is 46.3%;the largest degree of correlation is between the number of delivery and HDCP history.2.Multi-criteria screening in middle pregnancy:the number of delivery+BMI+history of chronic hypertension+HDCP history+UTA-PI’s AUC is 0.703(95%CI0.647-0.759),when prefect cutoff is 0.044,sensitivity is 51.5%,specificity is 83.8%,middle pregnancy of AUC is smaller than early pregnancy,it is 0.767(95%CI0.718-0.816).The PE detection rate is 52/101(51.5%).(3)Joint screening of early and middle pregnancy:1.The best combination of early and mid-pregnancy multi-criteria is the number of delivery+HDCP history+early MAP+early PAPP-A+middle UTA-PI,AUC is0.784(95%CI 0.734-0.834),when prefect cutoff is 0.036,the sensitivity is 70.3%,the specificity is 76.7%.The area under the ROC curve is slightly higher than early pregnancy.2.Joint screening mode of early and middle pregnancy:The early pregnancy and middle pregnancy integrated screening model:early pregnancyselecttomultipleindicatorsandmiddlepregnancyselect early-middle-pregnancy,then it obtains different risk groups,(1)a pair of high risk:the incidence rate is about 1/10.(2)Single high risk:the incidence rate is about 1/24.(3)double low risk:the incidence rate is only about 1/89.The detection efficiency is71/101 cases(70.3%).The early pregnancy and middle pregnancy sequential screening:In the early pregnancy and middle pregnancy,multiple screening programs are used,and different risk groups are identified,(1)high risk:the incidence rate is approximately 1/6.(2)Single high risk:the incidence rate is about 1/22,it is similar to the integrated screening.(3)double low risk:It is only about 1/98,the incidence is lower than the integrated screening.The detection efficiency of this program is 82/101 cases(81.2%).Second,fetal growth restriction:(1)Early pregnancy screening:1.Individual index screening in early pregnancy:a false positive rate of 5%,there are statistically significant the number of delivery,BPD,AC,HC,and FL.The multi-factorial analysis of the number of delivery and BPD is statistically significant;the number of delivery is FGR’s Risk factors;the BPD’s AUC is 0.607(95%CI0.537-0.677),when BPD cut-off value is 19.65mm,sensitivity is 56.9%,specificity is 62.1%.2.Multi-criteria screening in early pregnancy:the number of delivery+BPD’s AUC is0.622(95%CI 0.549-0.694),it is higher than the number of delivery and BPD,cutoff0.027,sensitivity 44.6%,specificity 78.2%.(2)middle pregnancy screening:1.Individual index screening in middle pregnancy:single factor analysis of screening in the middle of pregnancy,statistical significance is the number of delivery,BMI,BPD,AC,HC,FL,UTA-PI,UTA-RI,UA-PI,UA-RI,Statistical significance in multivariate analysis is BMI,AC,UTA-PI,UTA-RI,UA-PI,UA-RI;BMI,UTA-PI,UA-PI are risk factors for FGR,the largest risk factor is UTA-PI;AC has the largest AUC.When AC cutoff value is 165.95mm,sensitivity is 75.4%,specificity is 51.7%.AC and UA-PI are the most relevant.2.Multi-criteriascreeninginmiddlepregnancy:thelargstestAUCis BMI+AC+UTA-PI+UTA-RI+UA-PI+UA-RI,the AUC is 0.775(95%CI0.716-0.835),the best cut-off point is 0.019,the sensitivity is 73.8%,the specificity is 69.8%.(3)Joint screening of early and middle pregnancy:1.AUC of early and middle pregnancy combined screening is better than early pregnancy or middle pregnancy.AUC of the early pregnancy is less than middle pregnancy;The best combination screening program is early BPD+middle BMI+middle AC+middle UTA-PI+middle UTA-RI+middle pregnancy UA-PI+middle UA-RI,the best cutoff point is 0.015,sensitivity is 83.1%,specificity is 61.3%.2.Joint screening mode of early and middle pregnancy:The early pregnancy and middle pregnancy integrated screening model:This study was used in the early pregnancy and early-middle-pregnancy,we select different groups,(1)a pair of high risk:the incidence rate is as high as 1/15.(2)single high risk:the incidence rate is about 1/36.(3)double low risk:the incidence rate is only about1/176.Clinically,we select the best screening program for the early pregnancy of the study.the detection efficacy is 54/65(83.1%).The early pregnancy and middle pregnancy sequential screening:This study was used in the early pregnancy and middle pregnancy,we select different groups.(1)a pair of high risk:the incidence rate is about 1/10.(2)Single high risk:the incidence rate is about 1/40.(3)double low risk:the incidence rate is only about 1/139.the detection efficiency is 53/65(81.5%).The single screening pattern during the middle pregnancy:The efficacy is 48/65 cases(73.8%).In conclusion:First,pre-eclampsia:1 The clinical predictive value of simple early pregnancy screening is better than simple middle pregnancy screening.2 The combination of early pregnancy and middle pregnancy is more effective than simple early pregnancy or single middle pregnancy screening.sequential screening is used for stratified diagnosis and treatment of early pregnancy screening population.Second,fetal growth restriction:1 The efficiency of screening during simple middle pregnancy screening is higher than early pregnancy screening.The screening efficiency of FGR in early pregnancy is low,it is not recommended for clinical.2 The combination of early pregnancy and middle pregnancy is higher predictive efficiency than simple middle pregnancy screening.It is recommended that clinical application of integrated screening programs predict FGR.