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First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation

D'Silva, Arlenea; Fyfe, Rinab; Hyett, Jonb,c

Current Opinion in Obstetrics and Gynecology: December 2017 - Volume 29 - Issue 6 - p 367–374
doi: 10.1097/GCO.0000000000000420
WOMEN'S HEALTH: Edited by Joseph Aquilina

Purpose of review To summarize recent research findings related to first trimester prediction and prevention of adverse pregnancy outcomes associated with poor placentation. Recent publications related to prediction and prevention of preeclampsia, intrauterine growth restriction (IUGR) and stillbirth were reviewed.

Recent findings Researchers continue to identify markers that will help predict pregnancies that go on to develop preeclampsia through screening at 11–13+6 weeks. A number of multivariate algorithms describing risks for preeclampsia have been published and some of these have been validated in independent populations. A large randomized controlled trial has proven the efficacy of a first trimester prediction – prevention programme for preeclampsia with an 80% reduction in prevalence of disease leading to delivery less than 34 weeks. Screening tools for IUGR and stillbirth are less advanced and require further validation in other populations. The value of these models in preventing disease still needs to be demonstrated.

Summary Significant progress has been made in developing predictive and preventive strategies which can affect the prevalence of severe early-onset preeclampsia. This approach could be adopted for population-based screening aiming to prevent this disease.

aFaculty of Medicine, University of Western Sydney, Campbelltown, New South Wales

bRPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales

cDiscipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia

Correspondence to Professor Jon Hyett, RPA Women and Babies, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia. Tel: +61 2 9515 8887; fax: +61 2 9515 3811; e-mail: jon.hyett@sswahs.nsw.gov.au

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