Peer reviewed journal
Preeclampsia (PE) is one of the most common and dangerous pregnancy complications. High mortality and morbidity of mother and foetus refer to the need of early predicition and prevention of PE. In an attempt to screen early and to prevent PE many strategies have been studied. The author of this paper worked for 2 years in the Fetal Medicine Foundation (FMF) under the supervision of Professor Nicolaides and participated in the studies SPREE, ASPRE and EVENTS which lead to establishment of a new managment of PE. The purpose of this paper is to present the development and advantages of the combined screening in the 11 – 13+6 weeks for risk calculation of PE. Up to now the main result of the first-timester combined screening was the risk calculation of aneuploidies. Nowadays the results extended to pregnancy complications as PE, growth restriction and preterm delivery. The ASPRE study presented the efficacy in the preventive treatment of the high-risk patients for PE with aspirin 150 mg taken at bed time from 12 to 36 weeks. This year FMF proposed new screening strategies which depend on the biomarker (PAPP-A vs PlGF) used in the screen calculation. The best performance of screening for PE is achieved by applying PlGF. Since PAPP-A is used routinely as part of the screening for aneuploidies, its additive value was examined in different combinations of screening strategies and confirmed its application with similar detection rate as screening by PlGF. The most recent success was a development of the first-trimester screening for PE in twins.