June 18, 2019，the International Federation of Obstetrics and Gynecology (FIGO) issued a practical guide for early pregnancy screening and prevention. The guide was initiated by Professor Leona C. Poon from the Department of Obstetrics and Gynecology, Prince of Wales Hospital, Chinese University of Hong Kong, and successfully established the prediction of preeclampsia in the first trimester Model. With the release of the guidelines, the management of preeclampsia in the obstetrics and gynecology community has since opened a new era.
Preeclampsia (PE)It is a multi-system disease with an incidence of 2% to 5% in pregnant women. It is one of the main causes of maternal and perinatal morbidity and mortality, especially early-onset PE.Globally, approximately 76,000 women and 500,000 infants die from preeclampsia each year.
Although PEThe pathogenesis of preeclampsia is not clear, but it is currently confirmed that at least part of the pathogenesis of preeclampsia conforms to the two-stage theory. In the first stage, the trophoblast cell invasion is too shallow, resulting in insufficient remodeling of the spiral artery. Then the second stage occurs, that is, the imbalance between maternal angiogenic factors and anti-angiogenic factors, and endothelial dysfunction leads to clinical symptoms of the disease.
PE still cannot be achievedAccurate prediction and unified prevention. Effective prediction of PE in early pregnancy is to be able to identify high-risk groups of PE, so that necessary measures can be initiated as soon as possible to improve placenta formation and prevent or reduce the incidence of PE. In addition, identifying "at risk" groups can help tailor prenatal monitoring to predict and identify the onset of clinical syndromes and deal with them in a timely manner.
The purpose of FIGO's launch of this guide is:improve the PE the understanding of the relationship with the adverse outcomes of pregnant women and perinatal infants, as well as the understanding of the future health risks of mothers and offspring, and requires the development of a clear global health agenda to address this issue; the development of a consensus document for preterm PE in early pregnancy provide guidance on screening and prevention, and disseminate and encourage use.
● Old Age
● Primipara
● Past History Of Preeclampsia
● Shorter And Longer Pregnancy Intervals
● Assisted Reproduction
● Family History Of Preeclampsia
● Obesity
● Race And Ethnicity
● Gestational diabetes, chronic hypertension, kidney disease and autoimmune disease, anticardiolipin antibody syndrome (APS)Other comorbidities
Screening for preeclampsia in early pregnancy:
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1
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FIGO supports that preeclampsia in the first trimester should be screened in one step through the combination of early pregnancy detection and maternal risk factors, MAP, UTPI and PlGF. |
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2
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FIGO supports aspirin 150 among high-risk women defined in the combination test in the first trimesterMg/night should be during pregnancy 11-14+6Week starts，Until pregnancy 36Weekly during childbirth or when diagnosed with preeclampsia.
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The guidelines recommend the following singleton pregnancy screening procedures in the first trimester:
| Best Practice Recommendations |
Quality Of Evidence |
Recommended Level |
| Must accurately record maternal characteristics, medical history and obstetric history |
High⊕⊕⊕⊕ |
Powerful |
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MAP as PETesting as part of the risk assessment
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High⊕⊕⊕⊕ |
Powerful |
| The best biochemical marker is PlGF |
High⊕⊕⊕⊕ |
Powerful |
| Measure UTPI |
High⊕⊕⊕⊕ |
Powerful |
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