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  • Review Article

    Uterine Artery Doppler in Screening for Preeclampsia and Fetal Growth Restriction

    Rev Bras Ginecol Obstet. 2018;40(5):287-293

    Summary

    Review Article

    Uterine Artery Doppler in Screening for Preeclampsia and Fetal Growth Restriction

    Rev Bras Ginecol Obstet. 2018;40(5):287-293

    DOI 10.1055/s-0038-1660777

    Views4

    Abstract

    Objective

    To perform a comprehensive review of the current evidence on the role of uterine artery Doppler, isolated or in combination with other markers, in screening for preeclampsia (PE) and fetal growth restriction (FGR) in the general population. The review included recently published large cohort studies and randomized trials.

    Methods

    A search of the literature was conducted usingMedline, PubMed, MeSH and ScienceDirect. Combinations of the search terms “preeclampsia,” “screening,” “prediction,” “Doppler,” “Doppler velocimetry,” “fetal growth restriction,” “small for gestational age” and “uterine artery” were used. Articles in English (excluding reviews) reporting the use of uterine artery Doppler in screening for PE and FGR were included.

    Results

    Thirty articles were included. As a single predictor, uterine artery Doppler detects less than 50% of the cases of PE and no more than 40% of the pregnancies affected by FGR. Logistic regression-based models that allow calculation of individual risk based on the combination of multiple markers, in turn, is able to detect ~ 75% of the cases of preterm PE and 55% of the pregnancies resulting in small for gestational age infants.

    Conclusion

    The use of uterine artery Doppler as a single predictive test for PE and FGR has poor accuracy. However, its combined use in predictive models is promising, being more accurate in detecting preterm PE than FGR.

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    Uterine Artery Doppler in Screening for Preeclampsia and Fetal Growth Restriction
  • Letter to the Editor

    Preeclampsia: Universal Screening or Universal Prevention for Low andMiddle-Income Settings?

    Rev Bras Ginecol Obstet. 2021;43(4):334-338

    Summary

    Letter to the Editor

    Preeclampsia: Universal Screening or Universal Prevention for Low andMiddle-Income Settings?

    Rev Bras Ginecol Obstet. 2021;43(4):334-338

    DOI 10.1055/s-0041-1729953

    Views3
    Dear Editor, We read with interest the Clinical Consensus Recommendation about screening and prevention of preeclampsia published by De Oliveira et al. The authors recommend that identification of high-risk women should be based on maternal risk factors alone, and that universal treatment (of all pregnant women) with aspirin at a dose of 100 mg should be […]
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  • Original Article

    Preterm birth prediction: sequential evaluation of the cervix and the test for phosphorylated protein-1 linked to insulin-like growth factor

    Rev Bras Ginecol Obstet. 2013;35(9):394-400

    Summary

    Original Article

    Preterm birth prediction: sequential evaluation of the cervix and the test for phosphorylated protein-1 linked to insulin-like growth factor

    Rev Bras Ginecol Obstet. 2013;35(9):394-400

    DOI 10.1590/S0100-72032013000900003

    Views1

    PURPOSE: To investigate the usefulness of the measurement of cervical length and of the test for phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) performed sequentially in the prediction of preterm birth and the correlation between tests. METHODS: We analyzed data from 101 asymptomatic pregnant women with a history of premature delivery. The ultrasound measurement of cervical length and phIGFBP-1 test were performed in parallel every three weeks, between 24 and 34 week. The best cutoff value for each cervical evaluation was established by the ROC curve, and the two tests were compared using nonparametric tests. We determined the sensitivity, specificity and predictive values of each test and of the association of the exams for the occurrence of delivery before the 37th weeks. RESULTS: There were 25 preterm births (24.8%). The cervix length showed the highest sensitivity and was able to predict preterm birth in all evaluations, with similar accuracy at different gestational ages. The test for phIGFBP-1 was not helpful at 24 weeks, but was able to predict prematurity when performed at 27, 30 and 33 weeks. The combination of tests increased the sensitivity (81.8%) and negative predictive value (93.7%) when compared to the separate use of each test. The mean cervical length was lower in women with a positive test. CONCLUSIONS: Both cervical length and the test for phIGFBP-1 were able to predict premature delivery, and sequential combination of both tests showed a high sensitivity and high negative predictive value.

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    Preterm birth prediction: sequential evaluation of the cervix and the test for phosphorylated protein-1 linked to insulin-like growth factor
  • Review Article

    Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

    Rev Bras Ginecol Obstet. 2020;42(10):659-668

    Summary

    Review Article

    Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

    Rev Bras Ginecol Obstet. 2020;42(10):659-668

    DOI 10.1055/s-0040-1714135

    Views7

    Abstract

    Objective

    To identify the most effective procedures recommended for the prevention of preeclampsia.

    Data Sources

    A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via the Virtual Health Library (VHL). A manual search was also performed to find additional references. The risk of bias, the quality of the evidence, and the classification of the strength of the recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

    Selection of Studies

    In the initial search in the databases, the total number of articles retrieved was 351, and 2 were retrieved through the manual search; after duplicate articles were removed, 333 citations remained. After a thorough review of the titles and abstracts, 315 references were excluded. Accordingly, 18 articles were maintained for selection of the complete text (phase 2). This process led to the exclusion of 6 studies. In total, 12 articles were selected for data extraction and qualitative synthesis.

    Data Collection

    The articles selected for the study were analyzed, and we inserted the synthesis of the evidence in the online software GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. All right reserved. McMaster University, Hamilton, Ontário, Canada); thus, it was possible to develop a table of evidence, with the quality of the evidence and the classification of the strength of the recommendations.

    Data Synthesis

    In total, seven studies recommended the individual use of aspirin, or aspirin combined with calcium, heparin or dipyridamole. The use of calcium alone or in combination with phytonutrients was also highlighted. All of the studies were with women at a high risk of developing preeclampsia.

    Conclusion

    According to the studies evaluated, the administration of aspirin is still the best procedure to be used in the clinical practice to prevent preeclampsia.

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    Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

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