Preeclampsia screening with doppler or predictive algorithms: is their use recommended following the evidence-based clinical practice?
DOI:
https://doi.org/10.32385/rpmgf.v39i5.13346Keywords:
Preeclampsia, Screening, Pregnancy, Doppler, BiomarkersAbstract
Introduction: In the last years, algorithms to estimate the risk of preeclampsia in the first trimester have been developed, including some of them the uterine artery doppler. Due to the conviction of some physicians to add the doppler to obstetric echography, which is not subsidized by the Portuguese National Health Service, there is a need to clarify whether screening with these tools is beneficial.
Objectives: To evaluate if preeclampsia screening with the uterine artery Doppler or a predictive algorithm, compared with standard practice, has benefits in the maternofetal morbimortality.
Methods: The five-step approach of evidence-based clinical practice (EBCP) was adopted. First, a question was elaborated using the acronym PICO. The second involved the search of the evidence, which was found in the level of summaries, and was thus pre-appraised (third step). The fourth consisted in applying the evidence to the clinic context and the fifth was the reflection about that impact.
Results: The evidence collected is consistent between the three summary platforms (DynaMed, UpToDate, and BMJ Best Practice) where currently it is not recommended the preeclampsia screening with the doppler or predictive algorithms, because they don’t show a reduction of the maternofetal morbimortality. According to the analysis of the evidence, we attribute a weak/conditional recommendation. These results came essentially from three North American guidelines based on a systematic review of five clinical trials. The false positive rate with doppler is high in low-risk pregnancies and can lead to maternal anxiety and health costs.
Conclusion: Following the EBCP approach, we found that the use of these preeclampsia screening tools is not recommended, and they may be associated with potential risks (false positives, overdiagnosis). The screening should consist of the evaluation of the preeclampsia risk factors in the first prenatal appointment and the blood pressure measurement during the pregnancy.
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