Cieľ štúdie: Cieľom štúdie bolo zhodnotiť možnosti predikcie preeklampsie v prvom trimestri v rizikových graviditách. Typ štúdie: Prospektívna štúdia. Názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika Lekárskej fakulty Univerzity Komenského, Univerzitná nemocnica v Bratislave. Metodika: Štúdia zahŕňala 77 žien, ktoré boli vyšetrené v prvom trimestri medzi 11+0 a 13+6 gestačným týždňom od 1. 6. 2016 do 1. 6. 2017. Pacientky porodili do 31. 2. 2018. Štúdia bola schválená etickou komisiou a všetky pacientky podpísali informovaný súhlas. Do štúdie sme zahrnuli pacientky, ktoré mali minimálne jeden rizikový faktor pre vznik preeklampsie. Bolo realizované ultrazvukové vyšetrenie v prvom trimestri, zmerali sme pulzatívny index uterinnej artérie a tlak. Údaje o PAPP-A proteíne sme získali zo skríningového krvného testu. Tieto parametre boli použité na predikciu preeklampsie. Potom sme vyrátali senzitivitu a špecificitu. Preeklampsiu sme hodnotili podľa diagnostických kritérií American College Obstetricians and Gynecologists z roku 2013. V poslednej časti sme porovnali perinatálne výsledky u pacientok s preeklampsiou a kontrolnou skupinou. Štatistická analýza bola realizovaná IBM SPSS Statistics 25 Software. Rizikové faktory sme vyhodnotili pomocou Fisherovho exaktného testu a odds ratio. Mannov-Whitneyov test a one way analysis of variance boli použité na zistenie signifikantnosti prediktorov. Výsledky: Pacientky, ktoré otehotneli po asistovanej reprodukcii, mali signifikantne vyššiu pravdepodobnosť vzniku preeklampsie (odds ratio = 7,7; p = 0,028). Takisto pacientky s viacplodovým tehotenstvom mali vyššie riziko vzniku preeklampsie (odds ratio = 16,5; p = 0,031). Len stredný arteriálny tlak sa potvrdil ako signifikantný prediktor preeklampsie v 12. gestačnom týždni. Záver: Stredný arteriálny tlak je jednoduchý a nízkonákladový prediktor, ktorý má ale nízku senzitivitu 66,6 % a špecificitu 49 %.

Aim of study: Aim of study was to find out the possibility of prediction of pre-eclampsia in the first trimester among patients with risk factors. Type of study: Prospective study. Name and seat of workplace: 1st Department of Gynecology and Obstetrics, Comenius University in Bratislava, the University Hospital of Bratislava. Methods: Study included 77 women, who were examined in first trimester between 11+0 and 13+6 weeks of gestation from 1. 6. 2016 to 1. 6. 2017 in 1st Department of Gynecology and Obstetric in the Comenius University Hospital in the Bratislava and enlisted patients delivered until 31. 2. 2018. The study was approved by Hospital Ethics Committee and all patients signed consent form. We included patients, who ran at least one risk factor for developing pre-eclampsia, nulliparous, pregnancy after assisted reproduction technology, body mass index ≥ 25 in the beginning of pregnancy, age of patients and multiple gestation pregnancy. In addition, an ultrasound scans were performed in the first trimester. Doppler ultrasound pulsality index of uterine artery, pregnancy- -associated plasma protein and mean arterial pressure were used for prediction of the pre-eclampsia. Sensitivity and specificity of test were calculated. We assessed pre-eclampsia according to diagnostic criteria of the American College Obstetricians and Gynecologists. In the last part, we compared perinatal and maternal outcomes in the pre-eclampsia group and in the control group. Statistical analysis: Statistical analysis was realized by the IBM SPSS Statistics 25 Software. Risk factors were analysed by using Fisher exact test and Odds ratio. Mann-Whitney test and a one way analysis of variance were used for comparison the pre-eclampsia group and the control group. Results: Patients, whose had got conceived after assisted reproduction technology, had significant higher probability of pre-eclampsia (Odds ratio = 7.7, p = 0.028). Patients with multiple gestation pregnancy had also significant higher risk of pre-eclampsia (Odds ratio = 16.5, p = 0.031). Mean arterial pressure was only significant as predictive test in 12th weeks of gestation. Adverse perinatal outcomes and higher rate of cesarean section were in the preeclampsia group. Conclusion: Mean arterial pressure is easy to use and cost-effective predictor, but sensitivity was only 66.6% and specificity 49%.

1st Department of Gynecology and Obstetrics Comenius University and University Hospital Bratislava Slovakia

Institute of Medical Biology Genetics and Clinical Genetics School of Medicine Comenius University Bratislava Slovakia

Predikcia preeklampsie v prvom trimestri – pilotná štúdia