Abstract
ABSTRACT
Introduction
Preeclampsia is a major contributor to maternal and perinatal morbidity. First‐trimester predictive models for preterm preeclampsia have better efficacy than history‐based screening for prevention of this adverse pregnancy outcome. There are, however, few data describing implementation of this method of screening at a population level within public healthcare.
Materials and Methods
A retrospective service evaluation compared a historical cohort receiving standard maternity care and a contemporary cohort managed through the Initial Maternity Assessment and Planning (IMAP) service, a redesigned antenatal care approach focused on early multidisciplinary specialist maternity assessment and algorithm‐based preeclampsia screening prior to 14 weeks gestation. Singleton pregnancies within a metropolitan public hospital catchment were included. The primary outcome was preterm preeclampsia (leading to birth
Results
Historical and contemporary cohorts included 5 004 and 6 036 pregnancies, respectively. Median gestation at first visit decreased from 20 to 12 weeks. Analysis demonstrated a 49% reduction in the odds of preterm preeclampsia (0.91% to 0.60%; aOR 0.51, 95% CI 0.31–0.82) and a 59% reduction in the odds of severe preterm preeclampsia (0.38% to 0.20%; aOR 0.43, 95% CI 0.19–0.91). No significant differences were observed in early‐onset or term preeclampsia, fetal growth restriction, or complications related to antiplatelet therapy. The screen positive rate fell from 9.0% to 7.2%, while aspirin recommendation for high‐risk women increased from 23.9% to 77.8% overall and 98.2% in those receiving FMF screening.
Conclusion
A comprehensive, population‐based multidisciplinary first‐trimester assessment service, prioritizing FMF preeclampsia screening, can be successfully implemented within a public health setting and may be associated with lower odds of adverse clinical outcomes.