Dr Christine Gan1, Dr Sumathi Rajendran1, Dr Erin Vaughan1, Dr Ritu Mogra1
1Royal Prince Alfred Hospital
Biography:
Dr Christine Gan is currently a Senior Resident Medical Officer at the Royal Prince Alfred Hospital in Sydney. She has always had a passion for Obstetrics and Gynaecology. She strives to advocate for Women's Health. Outside of work, you can find her ocean swimming or baking.
Abstract:
Background: Pre-eclampsia (PE) affects 3-8% of pregnancies, significantly contributing to morbidity. The FMF first trimester algorithm, used between 11+0 and 13+6 weeks, identifies high-risk women and allows timely aspirin prophylaxis, reducing pre-term PE risk by 62%. How results determine subsequent antenatal care is not well described.
Aims: To evaluate pregnancy outcomes of women screened as extremely high risk for preeclampsia (>1:20) by the FMF algorithm and assess their antenatal care models. Primary outcome: development of preterm PE. Secondary outcomes: term preeclampsia, gestational hypertension, maternal ICU admission, newborn mortality, fetal growth restriction, and NICU admission. Antenatal care models were described.
Methods: A retrospective audit analyzed women who received first trimester FMF screening and delivered at our tertiary centre from 1 July 2019 to 30 June 2021. Inclusion criteria: women who screened extremely high risk (>1:20) for PE.
Results: Of 2362 women screened, 360 (15%) were high risk (>1:100), and 62 (3%) were extremely high risk (>1:20). These women were advised to commence aspirin for PE prevention. 44% (27/62) of women who screened extremely high risk, lacked significant clinical risk factors and were managed under a midwifery-care model unless complications arose. 23% (14/62) developed pre-eclampsia; 11% (7/62) preterm PE, 11% (7/62) developed PE after 37 weeks, including 6% (4/62) postpartum. There was one stillbirth (medically induced termination), while all other pregnancies resulted in live births. Among the newborns, 26% were growth-restricted, and 35% required NICU admission.
Conclusion: The FMF algorithm effectively detects and reclassifies women who would otherwise be considered low-risk based on clinical factors. Our findings demonstrate that this re-classified high-risk cohort is at significant risk of developing term or postpartum pre-eclampsia. By further risk-stratifying, we identified a group requiring medical-led care. We suggest ongoing PE education and closer monitoring as they approach term to ensure evolving pre-eclampsia is not overlooked.
Keywords
pre-eclampsia, high-risk, screening
References
1.WHO | The World Health Report 2005 – make every mother and child count [Internet]. [cited 2020 May 27]. Available from: https://www.who.int/whr/2005/en/
2.Rolnik DL, Wright D, Poon LCY, et al. ASPRE trial: Performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol. 2017;50:492–495.
3.Ontario Health (Quality). First-Trimester Screening Program for the Risk of Pre-eclampsia Using a Multiple-Marker Algorithm: A Health Technology Assessment. Ont Health Technol Assess Ser. 2022 Dec 8;22(5):1-118. PMID: 37772268; PMCID: PMC10530459.