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Rezk M, Gaber W, Shaheen A, Nofal A, Emara M, Gamal A, Badr H. First versus second trimester mean platelet volume and uric acid for prediction of preeclampsia in women at moderate and low risk. Hypertens Pregnancy 2018; 37:111-117. [PMID: 29893156 DOI: 10.1080/10641955.2018.1483508] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 04/16/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if second trimester mean platelet volume (MPV) and serum uric acid are reasonable predictors of preeclampsia (PE) or not, in patients at moderate and low risk. METHODS This prospective study was conducted on 9522 women at low or moderate risk for developing PE who underwent dual measurements of MPV and serum uric acid at late first trimester (10-12 weeks) and at second trimester (18-20 weeks) and subsequently divided into two groups; PE group (n = 286) who later developed PE and non-PE group (n = 9236). Test validity of MPV and serum uric acid was the primary outcome measure. Data were collected and analyzed. RESULTS Second trimester MPV is a good predictor for development of PE at a cutoff value of 9.55 fL with area under the curve (AUC) of 0.86, sensitivity of 95.2%, specificity of 66.7%, positive predictive value (PPV) of 87%, negative predictive value (NPV) of 85.7%, and accuracy of 86.7%. Second trimester serum uric acid is a good predictor for development of PE at a cutoff value of 7.35 mg/dL, with AUC of 0.85, sensitivity of 95.2%, specificity of 55.6%, PPV of 83.3%, NPV of 83.3%, and accuracy of 83.3%. Combination of both tests has a sensitivity of 100%, specificity of 22.2%, PPV of 75%, NPV of 100%, and accuracy of 76.7%. CONCLUSION Second trimester MPV and serum uric acid alone or in combination could be used as a useful biochemical markers for prediction of PE based on their validity, simplicity, and availability.
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Affiliation(s)
- Mohamed Rezk
- a Department of Obstetrics and Gynecology , Menoufia University , Shibin El-Kom City , Egypt
| | - Wael Gaber
- a Department of Obstetrics and Gynecology , Menoufia University , Shibin El-Kom City , Egypt
| | - Abdelhamid Shaheen
- a Department of Obstetrics and Gynecology , Menoufia University , Shibin El-Kom City , Egypt
| | - Ahmed Nofal
- a Department of Obstetrics and Gynecology , Menoufia University , Shibin El-Kom City , Egypt
| | - Mahmoud Emara
- b Department of Internal Medicine , Menoufia University , Shibin El-Kom City , Egypt
| | - Awni Gamal
- c Department of Cardiology , Menoufia University , Shibin El-Kom City , Egypt
| | - Hassan Badr
- d Department of Pediatrics, Faculty of Medicine , Menoufia University , Shibin El-Kom City , Egypt
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Talaulikar VS, Shehata H. Uric acid: is it time to give up routine testing in management of pre-eclampsia? Obstet Med 2012; 5:119-23. [PMID: 27582868 PMCID: PMC4989702 DOI: 10.1258/om.2011.110075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 11/18/2022] Open
Abstract
Ever since it was first linked with the pathophysiology of pre-eclampsia, uric acid has been a routine test requested by many care-givers managing pregnant women with hypertensive disease of pregnancy for almost 100 years. Existing evidence however suggests that it has no definitive role in prediction, diagnosis or management of pre-eclampsia. We argue against routine uric acid testing in pregnancies complicated by hypertension not only because it has become a fruitless academic exercise but also because ceasing its routine use will ensure cost-savings for the health services.
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Affiliation(s)
- Vikram Sinai Talaulikar
- Department of Obstetrics & Gynaecology, St George's Hospital and Medical School, Cranmer Terrace, Tooting, London SW17 0RE
| | - Hassan Shehata
- Maternal Medicine Unit, Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Surrey SM5 1AA
- St George's Medical School, Blackshaw Road, London SW17 0QT, UK
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Oh KJ, Park JS, Norwitz ER, Kim SM, Kim BJ, Park CW, Jun JK, Syn HC. Proteomic biomarkers in second trimester amniotic fluid that identify women who are destined to develop preeclampsia. Reprod Sci 2012; 19:694-703. [PMID: 22534327 DOI: 10.1177/1933719112438441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study investigated whether proteomic analysis of amniotic fluid (AF) in the early second trimester can be used to predict the development of preeclampsia. METHODS Amniotic fluid samples were collected at the time of genetic amniocentesis (15-19 weeks of gestation) from women who subsequently developed preeclampsia and from gestational age-matched normotensive controls (n = 10 for each). Amniotic fluid samples were subjected to proteomic analysis using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry, sodium dodecyl sulfate polyacrylamide gel coupled with in-gel tryptic digestion, electrospray ionization tandem mass spectrometry (MS/MS), immunodepletion assays, and enzyme-linke immunosorbent assay. RESULTS Five proteomic biomarkers were identified, which were differentially expressed in women who subsequently developed preeclampsia compared with those women who did not; four of these peaks were significantly upregulated (mass-to-charge ratio of 9080 [P = .006], 14 045 [P = .010], 14 345 [P = .049], and 28 087 [P = .006]) and one was significantly downregulated (mass-to-charge ratio of 4679 [P = .014]) in women who subsequently developed preeclampsia. Using electrospray ionization MS/MS and immunodepletion assays, two protein peaks were identified as albumin fragment and apolipoprotein A-I. CONCLUSIONS Using proteomic technology, this study identified protein biomarkers that are differentially expressed in the early second trimester AF from women who subsequently develop preeclampsia compared with women who remained normotensive. Early identification of women at risk of developing preeclampsia will allow clinicians to better optimize maternal and perinatal outcomes.
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Affiliation(s)
- Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Milne F. Action on Pre-eclampsia: Crisis and recovery. Pregnancy Hypertens 2011; 1:117-28. [DOI: 10.1016/j.preghy.2010.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Seong WJ, Chong GO, Hong DG, Lee TH, Lee YS, Cho YL, Chun SS, Park IS. Clinical significance of serum albumin level in pregnancy-related hypertension. J Obstet Gynaecol Res 2010; 36:1165-73. [DOI: 10.1111/j.1447-0756.2010.01296.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Anumba DOC, Lincoln K, Robson SC. Predictive Value of Clinical and Laboratory Indices at First Assessment in Women Referred with Suspected Gestational Hypertension. Hypertens Pregnancy 2010; 29:163-79. [DOI: 10.3109/10641950902968635] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Moodley J, Malleck N, Ramjee G, Randeree I. Clinical Significance of Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis of Urinary Proteins in Preeclampsia. Hypertens Pregnancy 2009. [DOI: 10.3109/10641959709069086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Etiology of Third-Trimester Maternal Hyperuricemia in Nonpreeclamptic Twin Gestations. Obstet Gynecol 2001. [DOI: 10.1097/00006250-200101000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paternoster DM, Stella A, Mussap M, Plebani M, Gambaro G, Grella PV. Predictive markers of pre-eclampsia in hypertensive disorders of pregnancy. Int J Gynaecol Obstet 1999; 66:237-43. [PMID: 10580670 DOI: 10.1016/s0020-7292(99)00078-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this work is to assess the most widespread methods currently proposed and two new markers for predicting the development of pre-eclampsia in pregnant women with hypertension. METHODS The study involved 212 pregnant Caucasian women: 104 normotensive, 68 pregnancy-induced hypertensive and 40 chronic hypertensive. Blood and urine were sampled between 28 and 30 weeks gestation. All 108 hypertensive pregnant women, at the time of sampling, demonstrated proteinuria below 0.3 g/24 h. The following laboratory tests were performed: fibronectin, antithrombin-III, alpha-1-microglobulin, U-N-acetyl-beta-glucosaminidase, uric acid and albumin excretion rate. Student's t-test, discriminant analysis and chi2 (chi-square) test were used as statistical methods. A P value less than 0.05 was considered significant. RESULTS After discriminating analysis, only three of the six variables analyzed were able to discriminate patients who would develop pre-eclampsia from the remaining hypertensive pregnant women: microalbuminuria, uric acid and fibronectin (chi2 = 29.122, P < 0.01). CONCLUSIONS In agreement with previous studies, albumin excretion rate appeared to be the best predictive test for pre-eclampsia in hypertensive pregnant women, giving a higher positive predictive value and specificity (87.5 and 98.9%, respectively).
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Affiliation(s)
- D M Paternoster
- Obstetric and Gynecology Department, Via Giustiniani, Padova, Italy
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Merviel P, Ba R, Beaufils M, Breart G, Salat-Baroux J, Uzan S. Lone hyperuricemia during pregnancy: maternal and fetal outcomes. Eur J Obstet Gynecol Reprod Biol 1998; 77:145-50. [PMID: 9578270 DOI: 10.1016/s0301-2115(97)00248-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Study of maternal and fetal consequences of lone hyperuricemia during pregnancy and demonstration that lone hyperuricemia is not a risk factor regarding the onset of preeclampsia. STUDY DESIGN Retrospective study of two groups of women, one found to have lone hyperuricemia during pregnancy (n=102) and the others with normal serum uric acid levels (n=100). RESULTS The only consequence identified of the lone hyperuricemia was a lower birth weight of children born to mothers found to have lone hyperuricemia for more than 2 weeks (P<0.05). CONCLUSIONS Lone hyperuricemia is not a risk factor regarding the onset of preeclampsia. It is therefore unnecessary to measure serum uric acid level during a normal pregnancy.
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Affiliation(s)
- P Merviel
- Department of Gynecology and Obstetrics, Tenon's Hospital, Paris, France
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Calvert SM, Tuffnell DJ, Haley J. Poor predictive value of platelet count, mean platelet volume and serum urate in hypertension in pregnancy. Eur J Obstet Gynecol Reprod Biol 1996; 64:179-84. [PMID: 8819999 DOI: 10.1016/0301-2115(95)02336-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the usefulness of platelet count, mean platelet volume and serum uric acid levels in the prediction of pre-eclampsia in women with mild hypertension in pregnancy, and to see if it is appropriate to base the management of such patients on these tests. SUBJECTS Three hundred and thirty-six women attending the antenatal day unit with a diagnosis of non-proteinuric hypertension in pregnancy (diastolic blood pressure > or = 90 mmHg on two separate recordings) from whom at least one blood sample was taken. MAIN OUTCOMES MEASURED The development of proteinuria (1+ or greater on urine Albustix); the need for oral antihypertensive medication, the need for the 'pre-eclampsia regime' intra- or post-partum; the need for induction of labour because of hypertension. RESULTS No test, at any cut-off level, was found to be of any use in predicting the outcomes studied. Nor was a weekly change in any of the tests found to be of any use. CONCLUSION Basing the management of patients with mild non-proteinuric hypertension on the results of platelet count, mean platelet volume or urate level is unwise as none of these tests was able to predict outcome in such patients.
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Abstract
A number of laboratory tests are available for the evaluation of the hypertensive gravida. These tests can be used to either predict and/or prognosticate between preeclampsia and other hypertensive disorders of pregnancy. These laboratory tests were evaluated based on published experience with special attention to its ability to facilitate identification of the patient with preeclampsia apart from other hypertensive disorders that co-exist with and occur as a complication of pregnancy. Hypocalciuria and increased cellular plasma fibronectin seem to be good tests to differentiate preeclampsia from chronic hypertension. The management of preeclampsia with its increased risk of perinatal morbidity and mortality renders this differentiation clinically very important. Hyperuricemia, proteinuria, increased serum beta-thromboglobulin concentration, abnormal red blood cell morphology with increased hemoglobin/hematocrit, and increased serum iron individually and collectively reflect the severity of preeclampsia. Platelets and total serum lactate dehydrogenase are the best tests to reflect the severity of HELLP syndrome. Circulating hCG and serum thromboglobulin seem to be the most promising future predictors for preeclampsia.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA
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Rinder HM, Bonan JL, Anandan S, Rinder CS, Rodrigues PA, Smith BR. Noninvasive measurement of platelet kinetics in normal and hypertensive pregnancies. Am J Obstet Gynecol 1994. [DOI: 10.1016/s0002-9378(13)70291-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rinder HM, Bonan JL, Anandan S, Rinder CS, Rodrigues PA, Smith BR. Noninvasive measurement of platelet kinetics in normal and hypertensive pregnancies. Am J Obstet Gynecol 1994; 170:117-22. [PMID: 8296812 DOI: 10.1016/s0002-9378(94)70395-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our purpose was to determine platelet kinetics in pregnancy by means of noninvasive reticulated platelet counts and to examine in a pilot study whether increased reticulated platelet values were associated with preeclampsia and pregnancy-induced hypertension. STUDY DESIGN Nulliparous women had blood samples drawn at enrollment (first prenatal visit) and at 28 and 36 weeks' gestation. The percent of reticulated platelets (an index of marrow platelet release correlating with increased thrombopoiesis), platelet-associated immunoglobulin, and serum antiplatelet antibody were measured and correlated with the clinical course for each patient. RESULTS In 31 normal pregnancies the percent of reticulated platelets was never significantly higher than the values for normal nonpregnant women (5.8% +/- 2.2%) in spite of a significant decrease in platelet count by 36 weeks. By contrast, the percent of reticulated platelets in four women with preeclampsia rose significantly to 13.9% +/- 11.2% at 28 weeks, before the onset of clinical signs. No women had evidence of immune platelet destruction. CONCLUSION In normal pregnancy the decline in platelet count is not accompanied by an increase in marrow platelet production, suggesting that the platelet decrease is dilutional without a compensatory thrombopoietic response or alternatively that thrombopoiesis is down-regulated during normal pregnancy. However, platelet production does increase before the onset of symptoms in a small number of women in whom preeclampsia or pregnancy-induced hypertension subsequently develops. These findings may justify a larger prospective study to determine whether noninvasive serial measurement of the percent of reticulated platelets can predict those pregnant women at risk for hypertension and preeclampsia.
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Affiliation(s)
- H M Rinder
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510
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Abstract
The signs and symptoms of preeclampsia are usually apparent at a relatively late stage in pregnancy (late second to early third trimester). However, the disorder results from abnormal interaction between fetal and maternal tissue much earlier in pregnancy, between 8 and 18 weeks' gestation. During the past two decades numerous clinical, biophysical, and biochemical tests have been proposed for the early detection of preeclampsia. Some of these tests are simple, whereas others are invasive; some have been studied extensively, while others are still under clinical investigation. A review of the literature indicates considerable disagreement regarding the sensitivity and predictive values of the various tests studied. The reported differences in the predictive values of these tests may be attributed to one or more of the following: populations studied, definition and prevalence of the disorder, techniques and methodology used in performing these tests, etc. As a result, there is disagreement regarding the ideal screening test to be used for identifying patients for clinical trials dealing with prevention of the disorder.
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Affiliation(s)
- G A Dekker
- Department of Obstetrics and Gynecology, Free University, Amsterdam, The Netherlands
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Affiliation(s)
- R A Fay
- Nepean Hospital, Penrith, New South Wales
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Forest JC, Massé J, Moutquin JM, Radouco-Thomas M. [Preeclampsia: physiopathology and prospects for early detection]. Clin Biochem 1989; 22:483-9. [PMID: 2692875 DOI: 10.1016/s0009-9120(89)80103-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Preeclampsia is a complication of pregnancy characterized by hypertension, edema and proteinuria, beginning after 20 weeks of gestation. Six percent of the pregnant women in North America develop this disease, which is associated with increased morbidity and mortality for the mother and her baby. The physiopathology remains uncertain despite many research efforts. Actual hypotheses seek to explain the vasospasm that characterizes the disease. Among the many factors influencing vascular reactivity and possibly implicated are: the renin-angiotensin system, prostaglandins, progesterone and its metabolites, calcium, magnesium, digoxin-like immunoreactive substance(s), auricular natriuretic factor, substances secreted by platelets and leukotrienes. Prevention of the disease is limited by the absence of a biological or clinical marker with good sensitivity and appropriate specificity. Many biochemical or hematological parameters have been reported: uric acid, calcium, magnesium, proteinuria, blood iron, hematocrit, platelet count, antithrombin III, estrogen and progesterone. The combination of several tests could be superior to the use of each test individually, providing a better sensitivity and improving the positive predictive value. With early detection, new therapies for the prevention of the disease could be experimented on the higher risk women before the apparition of clinical symptoms or signs. Furthermore, those tests could be used in the study of the pathophysiology and in the choice of the best therapy.
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Affiliation(s)
- J C Forest
- Département d'Obstétrique-Gynécologie, Hôpital St. François d'Assise, Quebec, Canada
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Stubbs TM, Lazarchick J, Van Dorsten JP, Cox J, Loadholt CB. Evidence of accelerated platelet production and consumption in nonthrombocytopenic preeclampsia. Am J Obstet Gynecol 1986; 155:263-5. [PMID: 3740135 DOI: 10.1016/0002-9378(86)90803-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Platelet size and the distribution of platelet sizes are both increased in preeclamptic patients with normal platelet counts. These changes suggest that accelerated platelet production and consumption are both widespread in preeclampsia.
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Writer WD. Anaesthetic considerations in high-risk pregnancy. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1986; 33:S16-27. [PMID: 3521801 DOI: 10.1007/bf03019152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The pathophysiology, and principles of obstetric and anaesthetic management, of two high-risk situations have been reviewed. Information sources related to two additional problems are provided. The encouraging decline witnessed in perinatal morbidity and mortality in recent years, stems from multidisciplinary team care in tertiary centres. The obstetric anaesthetist who understands the pathophysiology of high-risk pregnancy, and the principles which underlie patient management, becomes an irreplaceable member of such perinatal care teams.
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