Multiple-parameter screening and prevention of preeclampsia: Evaluation of a protocol implemented at Hospital Universitario Puerta de Hierro

espanolObjetivo: evaluar la implantacion, en nuestro centro, de un protocolo de cribado del riesgo de preeclampsia en poblacion de bajo riesgo obstetrico, combinado con tratamiento preventivo con 100 mg diarios de acido-acetilsalicilico, mediante el analisis de la variacion de la incidencia de preeclampsia. Validar la herramienta utilizada, analizando su capacidad predictiva. Material y metodos: se estudiaron 310 pacientes, distribuidas en dos grupos: 138 controles (TR) y 172 con cribado y tratamiento preventivo (CI). Se recogieron datos demograficos, edad gestacional en consulta, historia obstetrica, metodo reproductivo, factores de riesgo de preeclampsia (hipertension, diabetes, IMC, nefropatia y coagulopatia), toma de acido-acetilsalicilico de forma preventiva y datos del final de la gestacion (hipertension, proteinuria, diagnostico de preeclampsia y complicaciones). En el grupo CI se recogio el indice de riesgo, y en el grupo TR se calculo de forma retrospectiva. Resultados: la herramienta obtuvo una sensibilidad del 80% y una especificidad del 98,4%. La incidencia de preeclampsia resulto del 3,62% en el grupo TR frente al 0,58% en el grupo CI (p=0,053), con una OR de 0,155 [0,017-1,34]. Entre las pacientes con indice de alto riesgo, un 66,7% del grupo TR presento preeclampsia, frente a un 9,1% del grupo CI (p=0,027), con OR 0,05 [0,04-0,57] y una NNT de 1,74. Conclusiones: la herramienta utilizada tiene elevada sensibilidad y especificidad, resultando util como cribado. El protocolo implantado reduce la incidencia de preeclampsia en pacientes con indice de alto riesgo, aunque la variacion a nivel poblacional no fue significativa EnglishObjective: To evaluate the implementation in our center of a preeclampsia risk screening protocol in a low-risk population combined with preventive treatment (aspirin, 100 mg/d) by evaluating the variation in the incidence of preeclampsia. To validate the analysis tool and its predictive strength. Material and methods: We studied 310 patients divided into 2 groups: 138 controls (TR) and 172 patients who had undergone screening and received preventive treatment (CI). We collected demographic data, gestational age at consultation, obstetric history, reproductive method, risk factors for preeclampsia (hypertension, diabetes, BMI, kidney disease, and coagulopathy), use of aspirin as preventive therapy, and data on the outcome of pregnancy (hypertension, proteinuria, diagnosis of preeclampsia, and complications). In the CI group, we also recorded the risk of preeclampsia. This was calculated retrospectively in the TR group. Results: The protocol had 80% sensitivity and 98.4% specificity. The incidence of preeclampsia was 3.62% in the TR group and 0.58% in the CI group (p=0.053), with an OR of 0.155 (0.017-1.34). Among patients with a high risk, 66.7% developed preeclampsia in the TR group and 9.1% in the CI group (p=0.027), with an OR of 0.05 (0.04-0.57) and a number needed to treat of 1.74. Conclusions: The high sensitivity and specificity of the analytical tool make it adequate for screening. The protocol reduces the incidence of preeclampsia in high-risk patients, even if that difference was not significant at the level of the study population.