A new risk score model to predict preeclampsia using maternal factors and mean arterial pressure in early pregnancy

The purpose of this study was to establish a multivariable risk-scoring model for preeclampsia (PE) prediction based on maternal characteristics and mean arterial pressure (MAP). Multivariate logistic regression analysis from 4600 pregnancies during a 10-year period was used to create the best fitting model. Significant risk factors and weighted scores consisted of age ≥30 years (3), BMI ≥25 kg/m2 (2), multifetal pregnancy (9), history of PE (9), adverse perinatal outcomes (6), pregnancy interval >10 years (5), nulliparous (5), underlying renal disease (10), chronic hypertension (6), autoimmune disease (5), diabetes (2) and MAP ≥95 mmHg (5). The model achieved an ROC area 0.771 with detection rates of 34%, 44%, 53% and 58% at 5%, 10%, 15% and 20% fixed false-positive rates, respectively. The new risk score model could be a clinically useful screening tool for PE. Pregnant women who have total scores of 9–13 (high risk) and more than 14 (very high risk) should receive aspirin prophylaxis.Impact Statement What is already known on this subject? Preeclampsia (PE) is the major cause of maternal and perinatal mortality and morbidity; it can be prevented by antiplatelet agents. What the results of this study add? A new model for identifying maternal at risk for PE using clinical risk factors and MAP was created. Weighted scores were defined for each variable for easy use in clinical practice. According to their probability for PE, pregnant women were classified into three subgroups: low risk (score 0–8), high risk (score 9–13) and very high risk groups (score ≥ 14). Aspirin should be prescribed to high risk and very high risk groups. For safety concerns, very high risk pregnancies should have close antenatal surveillance in a tertiary care hospital to reduce adverse outcomes during pregnancy and childbirth. What the implications are of these findings for clinical practice and/or further research? This new model for identifying pregnant women at high risk for PE has the potential to reduce the morbidity and mortality associated with this disease

A predictive model for successfully inducing active labor among pregnant women: Combining cervical status assessment and clinical characteristics

Objective: To develop a predictive model for successfully inducing active labor by using a combination of cervical status and maternal and fetal characteristics. Study design: A retrospective cohort study was conducted among pregnant women who underwent labor induction between January 2015 and December 2019. Successfully inducing active labor was defined as achieving a cervical dilation > 4 cm within 10 h after adequate uterine contractions. The medical data were extracted from the hospital database; statistical analyses were performed using a logistic regression model to identify the predictors associated with the successful induction of labor. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the accuracy of the model. Results: In total, 1448 pregnant women were enrolled; 960 (66.3 %) achieved successful induction of active labor. Multivariate analysis revealed that maternal age, parity, body mass index, oligohydramnios, premature rupture of membranes, fetal sex, dilation, station, and consistency were significant factors associated with successful labor induction. The ROC curve of the logistic regression model had an AUC of 0.7736. For the validated score system to predict the probability of success, we found that a total score > 60 has a 73.0 % (95 % CI 59.0–83.5) probability of successful induction of labor into the active phase stage within 10 h. Conclusions: The predictive model for successfully achieving active labor using the combination of cervical status and maternal and fetal characteristics had good predictive ability

Agreement of three interpretation systems of intrapartum foetal heart rate monitoring by different levels of physicians

A prospective study was conducted in centre in Southern Thailand, to evaluate agreement in EFM interpretation among various physicians in order to find out the most practical system for daily use. We found strong agreement of very normal FHR tracings among the FIGO, NICHD 3-tier and 5-tier systems. The NICHD 3-tier was more compatible with the FIGO system than 5-tier system. Overall inter-observer agreement was moderate for the NICHD 3-tier system while inter-observer agreement of 5-tier system was fair also the intra-observer agreement was higher in the NICHD 3-tier system. So the 3-tier systems are more suitable than the 5-tier system in general obstetric practice.Impact statement What is already known on this subject: The 3-tier and 5-tier systems were widely used in general obstetrics practice. What the results of this study add: The inter- and intra-observer agreement of NICHD 3-tier system was higher than the 5-tier system. What the implications are of these findings for clinical practice and/or further research: The 3-tier systems were more suitable than the 5-tier systems in general obstetrics practice

The relationship between the values of MoM for PAPP-A [A] and free β-hCG [B] using the southern Thai median equation from this study on the X-axis, and the northern Thai equation [9] on the Y-axis (circles).

<p>The line represents the line of equity, i.e., marking the same values on both X and Y-axes.</p

Normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in a specific ethnicity

<div><p>Objective</p><p>To establish normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in southern Thai women, and to compare these reference levels with Caucasian-specific and northern Thai models.</p><p>Methods</p><p>A cross-sectional study was conducted in 1,150 normal singleton pregnancy women to determine serum pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) concentrations in women from southern Thailand. The predicted median values were compared with published equations for Caucasians and northern Thai women.</p><p>Results</p><p>The best-fitting regression equations for the expected median serum levels of PAPP-A (mIU/L) and free β- hCG (ng/mL) according to maternal weight (Wt in kg) and gestational age (GA in days) were: and Both equations were selected with a statistically significant contribution (p< 0.05). Compared with the Caucasian model, the median values of PAPP-A were higher and the median values of free β-hCG were lower in the southern Thai women. And compared with the northern Thai models, the median values of both biomarkers were lower in southern Thai women.</p><p>Conclusion</p><p>The study has successfully developed maternal-weight- and gestational-age-adjusted median normative models to convert the PAPP-A and free β-hCG levels into their Multiple of Median equivalents in southern Thai women. These models confirmed ethnic differences.</p></div

Surface of predicted median PAPP-A level (mIU/L) [A] and predicted median free β -hCG (ng/mL) [B] obtained from quantile regression models against gestational (days) and maternal weight (kg).

<p>In each figure, the left upper side is the result of the quantile regression using the southern Thai data, the right upper side is based on the published equation for median value for a Caucasian population [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182538#pone.0182538.ref008" target="_blank">8</a>], and the left lower side is based on the published equation for a northern Thai population [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0182538#pone.0182538.ref009" target="_blank">9</a>].</p

Median values of PAPP-A (mIU/L) [A] and free β -hCG (ng/mL) [B] according to gestational age (days).

<p>The circles represent the daily median value of the raw data. In each graph, the line is the predicted median from quantile regression against gestational age. The regression line is not adjusted for maternal weight.</p