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    Predição da pré-eclâmpsia pela dopplervelocimetria das artérias uterinas e pelos biomarcadores papp-a e plgf, entre 11 e 14 semanas de gestação
    (Universidade Federal de São Paulo (UNIFESP), 2015-11-27) Lobo, Guilherme Antonio Rago [UNIFESP]; Pares, David Baptista da Silva Pares [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: 1) To examine predictive value of uterine artery doppler, PAPP-A and PLGF, between 11-14 weeks gestation, in the prediction of preeclampsia (PE). 2) To validate first trimester FMF algorithm which combines maternal characteristics, mean arterial pressure (MAP), uterine artery doppler and biochemical markers in a Brazilian population. Method: Prospective observational study. 701 patients were recruited by the time of 11-14 weeks anomaly scan. 617 pregnant women comprised final sample (84 were excluded). In all of them demographic characteristics were recorded, MAP and mean pulsatility index (PI) obtained and PAPP-A and PLGF measured. Biophysical and biochemical markers were converted into MoM. All data was inserted on FMF software in order to calculate PE risk for each participant. Groups were formed on the basis of gestational age at delivery. Group 1 (n=7); delivery before 34 weeks. Group 2 (n=18); delivery before 37 weeks (includes group 1 patients plus delivery between 34-37 weeks). Group 3 (n=34); delivery before 42 weeks (includes group 2 patients plus delivery after 37 weeks). Control group (no PE / no GH) was composed by 517 women. Results: Mean PI MoM, PAPP-A MoM and PLGF MoM isolated performed equally in group 1 achieving a detection rate (DR) of 28,6%, for a 10% false positive rate (FPR). Markers performance in group 2 was 22,2%, 16,7% and 38,9%, respectively (10% FPR). Markers performance in group 3 was 20,6%, 11,8% and 26,5%, respectively (10% FPR). Combination markers that yelded highest area under the curve (AUC) for group 1 was mean PI MoM + PAPP-A MoM (AUC = 0,757) with a DR of 42,9% for 10% FPR. The combination of mean PI MoM + PAPP-A MoM + PLGF MoM had the best performance in group 2 and 3 (AUC = 0,711 and 0,682, respectively) with a DR of 38,9% and 35,3%, respectively, for 10% FPR. Detection rate achieved by FMF algorithm was 85,7%, 66,7% and 52,9% for groups 1,2 and 3, respectively, for a 10% FPR. Conclusion: First trimester mean PI, PAPP-A and PLGF performs poorly both isolated or in combination in the prediction of PE. FMF algorithm performance is quite good, particularly for the early onset subtype, comparable to the one obtained in the reference population.