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Objectives: Pre‐eclampsia (PE) causes substantial maternal and neonatal mortality and morbidity. In addition to the personal impact on women, children and their families, PE has a significant economic impact on our society. Recent research suggests that a first‐trimester multivariate model is highly predictive of preterm (< 37 weeks' gestation) PE and can be combined successfully with targeted prophylaxis (low‐dose aspirin), resulting in an 80% reduction in prevalence of disease. The aim of this study was to examine the potential health outcomes and cost implications following introduction of first‐trimester prediction and prevention of preterm PE within a public healthcare setting, compared with usual care, and to conduct a cost‐effectiveness analysis to inform health‐service decisions regarding implementation of such a program. Methods: A decision‐analytic model was used to compare usual care with the proposed first‐trimester screening intervention within the obstetric population (n = 6822) attending two public hospitals within a metropolitan district health service in New South Wales, Australia, between January 2015 and December 2016. The model, applied from early pregnancy, included exposure to a variety of healthcare professionals and addressed type of risk assessment (usual care or first‐trimester screening) and use of (compliance with) low‐dose aspirin prescribed prophylactically for prevention of PE. All pathways culminated in six possible health outcomes, ranging from no PE to maternal death. Results were presented as the number of cases of PE gained/avoided and the incremental increase/decrease in economic costs arising from the intervention compared with usual care. Significant assumptions were tested in sensitivity/uncertainty analyses. Results: The intervention produced, across all gestational ages, 31 fewer cases of PE and reduced aggregate economic health‐service costs by 1 431 186 Australian dollars over the 2‐year period. None of the tested iterations of uncertainty analyses reported additional cases of PE or higher economic costs. The new intervention based on first‐trimester screening dominated usual care. Conclusion: This cost‐effectiveness analysis demonstrated a reduction in prevalence of preterm PE and substantial cost savings associated with a population‐based program of first‐trimester prediction and prevention of PE, and supports implementation of such a policy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology [ABSTRACT FROM AUTHOR]

The current model was developed in a mixed population of 35 948 women with singleton pregnancy attending a routine visit at one of two UK hospitals, and a combination of maternal factors, uterine artery PI, MAP and PlGF can predict 90% of cases of early-onset pre-eclampsia, 75% of preterm pre-eclampsia and 41% of term pre-eclampsia, at a screen-positive rate of 10%[[31], [35]]. The PROGNOSIS study[19], a prospective observational study conducted in 14 countries, was designed to investigate the value of using the sFlt-1/PlGF ratio to predict the absence of pre-eclampsia within 1 week and to predict the presence of pre-eclampsia within 4 weeks in women with clinical suspicion of pre-eclampsia. PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFlt-1/PlGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor/BRAHMS PlGF plus Kryptor PE ratio). [Extracted from the article]

Objective: To assess the quality of mean uterine artery (UtA) pulsatility index (PI) measurement in a first-trimester pre-eclampsia screening program.Methods: Consecutive women with a singleton pregnancy attending first-trimester screening for fetal chromosomal abnormalities also had combined screening for pre-eclampsia based on the Fetal Medicine Foundation (FMF) algorithm, at a large practice in Sydney, Australia, from May 2014 to February 2017. Distributions of mean UtA-PI multiples of the median (MoM) on a logarithmic scale were plotted in relation to the normal median with 95% CI for each operator and for each month. Central tendency and dispersion and cumulative sum charts were produced. Mean UtA-PI MoM values between 0.95 and 1.05 were considered ideal and those between 0.90 and 1.10 were considered acceptable. The screen-positive rates for preterm pre-eclampsia in different groups of sonographers according to their mean log10 UtA-PI MoM were calculated and compared using the chi-square test.Results: A total of 21 010 women attended for first-trimester ultrasound and had screening for pre-eclampsia. The overall median UtA-PI MoM was 1.042 (interquartile range (IQR), 0.85-1.26). Of 46 sonographers, 42 (91.3%) performed more than 50 examinations and, of those, 41 (97.6%) measured UtA-PI within the acceptable range. Sonographers measuring UtA-PI MoM on average below 0.95 and those measuring it above 1.05 had, respectively, lower and higher screen-positive rates when compared with those with measurements within the 0.95-1.05 UtA-PI MoM interval (7.2% and 13.2% vs 11.2%, respectively, P < 0.001).Conclusion: UtA Doppler is measured well among trained operators when following an established protocol. While slight variations are expected, systematic error in this measurement impacts on the screen-positive rate. Therefore, a quality control process should be in place and retraining of staff may be required. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: Pre-eclampsia (PE) remains a leading cause of maternal and fetal morbidity and mortality. A first-trimester screening algorithm predicting the risk of early-onset PE has been developed and validated. Early prediction coupled with initiation of aspirin at 11-13 weeks in women identified as high risk is effective at reducing the prevalence of early-onset PE. The aim of this study was to evaluate the cost-effectiveness of this first-trimester screening program coupled with early use of low-dose aspirin in women at high risk of developing early-onset PE, in comparison to current practice in Canada.Methods: A decision analysis was performed based on a theoretical population of 387 516 live births in Canada in 1 year. The clinical and financial impact of early preventative screening using the Fetal Medicine Foundation algorithm for prediction of early-onset PE coupled with early (< 16 weeks) use of low-dose aspirin in those at high risk was simulated and compared with current practice using decision-tree analysis. The probabilities at each decision point and associated costs of utilized resources were calculated based on published literature and public databases.Results: Of the theoretical 387 516 births per year, the estimated prevalence of early PE based on first-trimester screening and aspirin use was 705 vs 1801 cases based on the current practice. This was associated with an estimated total cost of C$9.52 million with the first-trimester screening program compared with C$23.91 million with current practice for the diagnosis and management of women with early-onset PE. This equals an annual cost saving to the Canadian healthcare system of approximately C$14.39 million.Conclusions: The implementation of a first-trimester screening program for PE and early intervention with aspirin in women identified as high risk for early PE has the potential to prevent a significant number of early-onset PE cases with a substantial associated cost saving to the healthcare system in Canada. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

An editorial is presented of the important aspects on the clinical implementation of early screening for and prevention of pre-eclampsia (PE). It explores the impact of PE on perinatal and maternal health and the early-onset of PE leading to preterm delivery. The evidence on the effectiveness of aspirin in reducing the risk of preterm PE by more than 60% and the risk of early-onset PE by more than 80% when given to high-risk women is explored.

To assess the performance of first trimester combined screening for preterm pre-eclampsia (PE) in Australia. Conclusions First trimester combined PE screening performed well in a large Australian population, and future studies should account for the effect of treatment. VP37.10: Performance of routine first trimester combined screening for preterm pre-eclampsia after multicentre clinical implementation in Australia. [Extracted from the article]

To assess pregnancy outcomes following first trimester combined screening for preterm pre-eclampsia (PE). OC07.06: Pregnancy outcomes following multicentre clinical implementation of routine first trimester screening for preterm pre-eclampsia in Australia Conclusions First trimester screening for PE identified a group at high risk of adverse outcomes who could benefit from aspirin prophylaxis and low-risk women who may be suitable for less intensive antenatal care. [Extracted from the article]

Objectives To assess the effect of audit and feedback on the performance of first-trimester uterine artery pulsatility index ( UtA-PI) measurement, to determine whether operator experience affects performance and whether an operator's measurement profile affects the screen-positive rate for early-onset pre-eclampsia ( PE). Methods This was a prospective cohort study in which UtA-PI measurements were collected between 11 to 13 + 6 weeks' gestation by 12 operators and were entered into individualized calculators to convert them to multiples of a locally-derived median ( MoM). Individual sonographer cumulative sum ( CUSUM) and target charts were generated to assess central tendency and dispersion to identify systematic measurement errors and deviation from expected measurement performance. Six of the operators received regular feedback whilst the remaining six received no feedback. Each group consisted of four experienced operators and two relatively inexperienced operators. The average MoM for each operator was compared with their respective screen-positive rates for early-onset PE. Results The group that received feedback performed better than that which received none, with results more closely matching the expected measurement distribution. UtA-PI measurements were comparable between the experienced and inexperienced sonographers (mean log10 lowest PI MoM, -0.0089 vs 0.0124, respectively); however the inexperienced sonographers had a higher overall screen-positive rate for early-onset PE (10.0% vs 2.7%, respectively). There was a significant positive correlation between the mean MoM for each operator and the screen-positive rate ( r = 0.63). Conclusions CUSUM and target graphs are an effective method of audit for first-trimester UtA-PI measurement. Feedback to operators resulted in improved measurement performance, which will ultimately result in improved screening accuracy for PE. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives The aims of this study were to investigate if (i) urinary concentrations of activin A and inhibin A are altered in pre-eclampsia (PE) and (ii) to study the relationship between uterine vein and peripheral vein concentrations of these hormones in PE patients. Design and method In a retrospective study, maternal peripheral vein and uterine vein serum and maternal urine samples collected at the time of delivery were analysed. There were three groups of patients; (i) group 1: term normal pregnancies ( n = 19) (ii) group 2: patients who developed PE ≤ 37 weeks ( n = 17) and (iii) group 3: patients who developed PE 37–40 weeks ( n = 8). Serum and urinary activin A, follistatin, inhibin A and pro alpha C and urinary creatinine levels were measured using enzyme immunoassays in the laboratory. Results Normal pregnant urine samples had very low levels of activin A and inhibin A. Both groups 2 and 3 PE patients had significantly higher levels of inhibin A ( P < 0·001) and activin A ( P < 0·001) compared to the controls. Pro-alpha C was not altered and follistatin was below the detection limit of the assay in the urine. Maternal peripheral serum activin A and inhibin A were significantly higher in groups 2 ( P < 0·001) and 3 ( P < 0·05) patients compared to the controls. Pro-alpha C-containing inhibins were higher in group 2 patients ( P < 0·05) compared to the controls in the peripheral circulation. Uterine vein serum activin A and inhibin A levels were also significantly higher in groups 2 ( P < 0·001) and 3 ( P < 0·05) patients compared to the controls. There was a highly significant positive correlation between peripheral and uterine vein serum concentrations of activin A, follistatin, inhibin A and pro alpha C, suggesting the same source for these proteins in PE. Conclusion Urinary activin A and inhibin A are raised in groups 2 and 3 PE patients. The magnitude of rise (> 25-fold) suggests these proteins may rise in patients before the onset of the clinical symptoms of PE. Uterine vein levels of these proteins are also raised in PE. [ABSTRACT FROM AUTHOR]

P13.04: A combination of ultrasound features and maternal biochemistry can predict pre-eclampsia prior to 11 weeks of gestation The aim of this research is to determine if trophoblast thickness (TT) and/or volume (TV) measured prior to 11 weeks gestation can predict PET either in isolation or in conjunction with maternal serum biochemistry. Comparison of MoM values for TV, PIGF and AFP demonstrated significant variation between pregnancies with normal outcomes (n = 971) compared to those that developed PET (n = 6). [Extracted from the article]

Workshops are an integral component of the annual International Federation of Placenta Association (IFPA) meeting, allowing for networking and focused discussion related to specialized topics on the placenta. At the 2015 IFPA meeting (Brisbane, Australia) twelve themed workshops were held, three of which are summarized in this report. These workshops focused on various aspects of placental function, particularly in cases of placenta-mediated disease. Collectively, these inter-connected workshops highlighted the role of the placenta in fetal programming, the use of various biomarkers to monitor placental function across pregnancy, and the clinical impact of novel diagnostic and surveillance modalities in instances of late onset fetal growth restriction (FGR). [ABSTRACT FROM AUTHOR]

An abstract of the article "Clinical evaluation of a 12-week risk algorithm predicting the onset of pre-eclampsia requiring delivery < 34 weeks gestation," by F. Park, C. Leung, S. Rothwell, R. Narayan, and J. Hyett is presented.

An abstract of the research paper "Maternal cardiac function in women deemed high-risk for pre-eclampsia with subsequent normal and adverse outcomes," by K. Russo and colleagues is presented.