Samrakshan: Rationale for universal 1st trimester screening to identify pregnant women at risk for preterm preeclampsia
Samrakshan, a nationwide program of the Indian Radiological & Imaging Association (IRIA) launched in June 2019, aims to optimize the experience and expertise of radiologists in India to supplement and complement existing efforts that address perinatal mortality in India. Samrakshan aims at a pragmatic approach cognizant of local realities and flexible that it can be adopted by many rather than a few.
This article discusses the protocol and the rationale of the 1st trimester opportunistic screening implemented through the Samrakshan program, with a specific focus on Pre-eclampsia (PE).
Some Key takeaways are:
-- Samrakshan recommends the use of validated digital automated or semi automated oscillometry machines to measure BP. It also recommends calibrating the machines at least once every 3-4 months. The use of digital oscillometry machines are recommended.
-- Measurements of Uterine Artery PI: Samrakshan recommends the use of a standardized protocol, as advised by the Fetal Medicine Foundation and the International Society of Ultrasound in Obstetrics and Gynaecology.
-- Screening Protocol:
1. Samrakshan recommends a risk-based screening for preterm PE using various biomarkers based on the available global evidence.
2. Current evidence indicates that a checklist approach based on maternal history and risk factors alone is no longer sufficient to identify pregnant women at high risk for preterm PE.
3. The competing risk Bayesian based algorithm or model has a higher detection rate.
4. The detection rates of preterm PE will be reduced in the absence of biochemical biomarkers, PLGF, however, currently it is a pragmatic reality in India that biochemical biomarkers have to be optional given issues with affordability, accessibility and availability.
5. Samrakshan recommends a paradigm shift to a one step 1st trimester screening including MAP and Uterine Artery PI Doppler studies for all pregnant women at 11-13+6 weeks.
Read more: http://fetalradiology.in/2019/11/14/2908/