Objective To estimate the risk of term pre-eclampsia (PE) in women who screened positive for preterm PE in the first trimester and to assess the impact of screening method and timing of delivery on the risk of developing term PE. Design Retrospective observational cohort study. Setting Tertiary referral hospital in London, United Kingdom. Population A total of 1802 women with singleton pregnancies screened for PE using maternal risk factors per NICE guidelines and who delivered at term (≥37 weeks’ gestation). Methods The Fetal Medicine Foundation (FMF) combined screening algorithm was retrospectively applied to the cohort using maternal risk factors, mean arterial pressure (MAP), and pregnancy-associated plasma protein-A (PAPP-A). Women were stratified by FMF screening result and timing of delivery. Outcomes were compared between those delivering before 40 weeks and those delivering at or after 40 weeks. Main Outcome Measures The primary outcome was incidence of term PE. Secondary outcomes included pregnancy-induced hypertension, low birthweight, birthweight centile, emergency caesarean section, and neonatal admissions. Results FMF screening identified 12.4% of women as screen-positive versus 9.4% with NICE. Among FMF screen-positive women, term PE incidence was significantly higher in those delivering at ≥40 weeks compared to those delivering at 37 +0–39 +6 weeks (28% vs. 13.4%, p = 0.008). Delivery at 38 +0–39 +6 weeks prevented one PE case per seven women; delivery at 39 +0–39 +6 weeks prevented one case per six. Conclusions Timed delivery before 40 weeks in FMF screen-positive women may significantly reduce the risk of term PE. Further studies are needed to optimise delivery strategies for this population.

Objective: Investigate cost effectiveness of first trimester preeclampsia screening using the Fetal Medicine Foundation (FMF) algorithm in comparison to standard care. Design: Retrospective observational study Setting: London tertiary hospital Population: 5957 pregnancies screened for preeclampsia using the National Institute for Health and Care Excellence (NICE) method. Methods: Differences in pregnancy outcomes between those who developed preeclampsia, term preeclampsia and preterm preeclampsia were compared by the Kruskal-Wallis and Chi-square tests. The FMF algorithm was applied retrospectively to the cohort. A decision analytic model was used to estimate costs and outcomes for pregnancies screened using NICE and those screened using the FMF algorithm. The decision point probabilities were calculated using the included cohort. Main outcome measures: Incremental healthcare costs and QALY gained per pregnancy screened. Results: Of 5957 pregnancies, 12.8% and 15.9% were screen positive for the development of preeclampsia using the NICE and FMF methods, respectively. Of those screen positive by NICE recommendations, aspirin was not prescribed in 25%. Across the three groups: pregnancies without preeclampsia, term preeclampsia and preterm preeclampsia, respectively there was a statistically significant trend in rates of emergency caesarean (21%, 43%, 71.4%; p=<0.001), admission to neonatal intensive care unit (NICU) (5.9%, 9.4%, 41%; p=<0.001) and length of stay in NICU. Use of the FMF algorithm was associated with 7 fewer cases of preterm preeclampsia, cost saving of £9.06 and a QALY gain of 0.00006/pregnancy screened. Conclusions: In our cohort, using a conservative approach, application of the FMF algorithm achieved clinical benefit and an economic cost saving.

Objective To examine the antenatal imaging features, intrapartum findings and early postpartum course of pregnancies with trisomy 21 (T21). Design Ten-year retrospective review Setting A tertiary hospital in the United Kingdom Population Women with a pregnancy affected by T21, who did not have a termination. Methods Women with pregnancies diagnosed with T21 on: antenatal karyotyping; karyotyping of post-mortem tissue and postnatal karyotype samples, from February 2010-2020. Main Outcome Measures Antenatal imaging findings, fetal growth restriction (FGR), birthweight, mode of delivery, and early neonatal outcomes. Results Seventy-six women with a fetus affected by T21 were identified. There were 6 intrauterine deaths, and 70 livebirths. Thirty-eight (50%) had an antenatal diagnosis and twenty-five (33%) had a suspected diagnosis but declined further testing. The diagnosis was unanticipated in 13 (17%). Cardiac anomalies (n=27) were the most common antenatal anomaly. Doppler abnormalities were apparent in 48/73 (68%). Eighteen (25.7%) had ultrasound evidence of FGR. The majority delivered by Caesarean section, and 21.4% of babies weighed below the 3rd percentile at delivery. Fifty-eight (82%) were admitted to the neonatal unit. Forty-three (61%) required respiratory support and fifty-five (78%) either needed naso-gastric feeding or were nil by mouth. Mean PAPP-A values were significantly lower in cases with abnormal Dopplers, FGR, congenital anomalies and with a birthweight below the 10th percentile. Conclusions Fetuses with T21 have high rates of placental insufficiency. FGR and Doppler abnormalities are common. Postnatally, the majority will require respiratory and feeding support. Antenatal counselling and protocols should reflect these risks. Funding None