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By Dr. Zarinah G. Gonzaga, Obstetrician-Gynecologist | April 07, 2021
Identifying a high-risk pregnancy can be live-saving. One of these high-risk conditions is hypertension in pregnancy. In the Philippines, preeclampsia and eclampsia were the cause of up to 30% of maternal deaths according to the Department of Health Philippine Health Statistics of 2017.
Preeclampsia, a dangerous condition that may occur during pregnancy, can lead to serious complications for both mother and baby. Preeclampsia may result in seizures (or eclampsia) and liver and kidney failure. Hypertensive disorders of pregnancy and the postnatal period can also lead to several long-term problems including complications in future pregnancies and elevated lifetime risk of non-communicable diseases including cardiovascular disease, kidney disease, diabetes, obesity, and mental illness.
At The Medical City’s Institute for Women’s Health, the Section of Maternal Fetal Medicine has a comprehensive predictive, preventive, and precise approach for pre-eclampsia detection and prevention that follows international recommendation.
This comprehensive screening is most accurate primarily because it combines the woman’s own risk factors with findings on ultrasound and the levels of biochemical markers in the mother’s blood. The accuracy of TMC’s first trimester prenatal screening program is documented in a study by Javier and Gonzaga[i] published in the Philippine Journal of Obstetrics and Gynecology. Compared with the UK and US screening recommendation using the mother’s risk factors alone, TMC’s combined first trimester screening is able to detect more women who are at risk for preeclampsia, either early or late during their pregnancy. This means the TMC preeclampsia screening can identify 9 out of 10 women who will eventually develop hypertension in pregnancy.
Figure 2. Accuracy of TMC’s combined first trimester screening compared with screening using maternal history alone.
Not only is TMC’s first trimester preeclampsia screening accurate, it has also been found to be cost-effective. Presented in the Philippine Obstetrical and Gynecological Society annual convention in 2020, a study by Violago and Quinio[i] documents the cost-benefit of having the first trimester screening followed by appropriate preventive measures for those at high risk. Prevention of preeclampisa using the first trimester screening followed by aspirin therapy for those at high risk can save the patient as much as P70,000 compared with the incremental cost of managing preeclampsia when it occurs.
[i] Javier MJ, Gonzaga ZG. Comparison of the diagnostic accuracy of early screening of preeclampsia by NICE guidelines, ACOG guidelines and comprehensive first trimester screening using maternal characteristics, ultra-sonographic findings and maternal serum biochemical markers. Phil J Obstet Gynecol, (2018); 42(6):26-38.
[i] Violago, CJ, Quinio IB, Cost-effectiveness of first trimester screening for preeclampsia and prevention of disease through initiation of aspirin therapy in a tertiary hospital, Presented in the POGS Virtual Annual Conference, November 2020
The article was written by Dr. Zarinah G. Gonzaga, Obstetrician-Gynecologist from The Medical City Institute for Women’s Health.
Dr. Zarinah G. Gonzaga is an Obstetrician-Gynecologist from The Medical City Institute for Women’s Health.
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