ObstetricsCan antenatal clinical and biochemical markers predict the development of severe preeclampsia?*
Section snippets
Material and methods
To develop a clinical prediction rule to discriminate patients at highest risk for severe preeclampsia we performed a retrospective cohort study of all pregnant patients with singleton gestations from 1995 through 1997 who underwent second-trimester multiple-marker screening, also known as the triple screen. Patient records were selected from a database of multiple-marker screening test results. In all cases serum screening was performed between 15 and 20 weeks’ gestation. Serum screening
Results
Among the 1998 patients we found 128 cases of preeclampsia (prevalence, 6.4%) and 49 cases of severe preeclampsia (prevalence, 2.5%). In the bivariate analysis case patients with severe preeclampsia were more likely to be nulliparous; to have a history of preeclampsia, autoimmune diseases, and chronic hypertension; to have an elevated (>90 mm Hg) screening MAP and third-trimester MAP; and to have a low second-trimester unconjugated estriol concentration (<0.9 MoM; Tables I and II).
Comment
Being able to predict which patients are at greatest risk for development of severe preeclampsia would be of great value in preventive and interventional studies because it would be possible to discriminate a high-risk population that could benefit from more aggressive treatment and intense observation. With this in mind, we sought to develop a clinical prediction model for severe preeclampsia through a retrospective cohort study. We chose to focus on prediction of severe preeclampsia because
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Reprint requests: David M. Stamilio, MD, USAF David Grant Medical Center, Department of Obstetrics and Gynecology, 101 Bodin Cir, Travis AFB, CA 94535-1800.