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Reuters Health Information (2007-04-09): Placenta function profile in second trimester identifies high-risk pregnancies


Placenta function profile in second trimester identifies high-risk pregnancies

Last Updated: 2007-04-09 9:04:05 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A triad of screening tests for women with high-risk pregnancies differentiates between those who are likely to have favorable outcomes and those at very high risk for severe complications due to placental disease, investigators at the University of Toronto report.

Preeclampsia, abruption and/or intrauterine growth restriction are frequently associated with placental insufficiency, Dr. Meghana Toal and her team note in the American Journal of Obstetrics and Gynecology for April. They tested the hypothesis that placental abnormalities can be identified at a stage of pregnancy when clinical interventions are still possible.

Multiple studies have revealed associations between serious problems and abnormal serum levels of alpha-fetoprotein or human chorionic gonadotropin at 16 to 18 weeks, high-resistance uterine artery Doppler waveforms at 18 to 23 weeks, and abnormal shape or texture of the placenta, Dr. Toal and her associates point out.

To assess how well these three parameters could identify placental defects, they identified 212 patients considered to be at high risk who had been treated at their clinic between 2000 and 2004.

Abnormal placental morphology was found in 40, abnormal uterine artery Doppler imaging in 57, and abnormal maternal serum screening results in 41. Of the group, 125 women had normal results on all three tests.

Compared with patients with one or more abnormal test results, in women with normal results the odds ratios were 0.1 to 0.2 for preeclampsia or HELPP (hemolysis, elevated liver enzymes and low platelets) syndrome, preterm delivery at < 34 weeks or infants small for gestational age.

In addition, the group of patients with two or three abnormal test results included approximately three out of every four pregnancies with severe early-onset growth restriction and pregnancies with intrauterine fetal death.

A placental profile can therefore predict early which women will require weekly care, patient education, and selective use of antihypertensive agents and corticosteroids, in order to optimize the fetal condition before delivery, the investigators conclude.

Furthermore, the women with completely normal placental profiles can be reassured that they are likely to experience no severe complications during their pregnancies, Dr. Toal and her associates point out.

Am J Obstet Gynecol 2007;196.

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