Screening

All pregnant women should be seen regularly throughout their pregnancy, and have their blood pressure (BP) measured.[65]​ If hypertension (defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg) is found, and pre-eclampsia suspected, urinalysis is recommended.[65]​ If high blood pressure persists, there should be a step-up in care to an assessment centre or admission to a care facility, depending on findings and symptoms.

Uterine artery Doppler is not recommended as a stand-alone screening tool for predicting the onset of disease.[1][16][54]​​[66]

Screening for pre-eclampsia by identifying women in the first trimester with risk factors for the disease is advocated by the UK National Institute for Health and Care Excellence.[16] Meta-analyses have shown a 53% risk reduction in pregnant women who are at moderate or high risk for developing pre-eclampsia who are picked up by screening through antenatal care and offered aspirin prophylaxis from 12 to 16 weeks’ gestation.[67]

Prediction algorithms that use a combination of biomarkers and maternal history have also been evaluated for their potential as first-trimester screening tools for pre-eclampsia.[68][69] In the ASPRE trial, >26,000 women with singleton pregnancies were screened with an algorithm that combined known maternal risk factors with mean arterial pressure (MAP), the uterine-artery pulsatility index (UTPI), and maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) taken at 11 to 13 weeks’ gestation.[41] After adjustment for the effect of aspirin, detection rates for preterm and term pre-eclampsia were 77% and 43%, respectively, with a false-positive rate of 9.2%.[70]

The Federation of Gynecology and Obstetrics (FIGO) recommends that all women should be screened for preterm pre-eclampsia using a first‐trimester combined test as a one‐step procedure.[20] FIGO suggests that the optimal test includes maternal risk factors and measurements of MAP, serum PlGF, and UPTI. If it is not possible to measure PlGF and/or UTPI, the baseline screening test should be a combination of maternal risk factors with MAP, and not maternal risk factors alone. An algorithm tool derived from these factors, with the option to include serum PAPP-A, is available. The Fetal Medicine Foundation: risk for preeclampsia assessment Opens in new window If resources are limited, FIGO suggests routine screening for preterm pre-eclampsia by maternal factors and MAP should be performed in all pregnancies.[20]

Although the US Food and Drug Administration (US FDA) has approved the sFlt-1/PlGF test to aid risk assessment for the progression to pre-eclampsia with severe features, the American College of Obstetricians and Gynecologists does not recommend any single biomarker test (e.g., PlGF testing or the sFlt-1/PlGF ratio) for the prediction of pre-eclampsia, diagnosis or exclusion of pre-eclampsia with severe features, or determination of the management approach after a positive or negative test result.[1][60]

A lack of screening availability may lead to a more acute presentation of pre-eclampsia, with increased risk of clinical sequelae.

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