1
|
Trilla C, Luna C, De León Socorro S, Rodriguez L, Ruiz-Romero A, Mora Brugués J, Benítez Delgado T, Fabre M, Martin Martínez A, Ruiz-Martinez S, Llurba E, Oros D. First-Trimester Sequential Screening for Preeclampsia Using Angiogenic Factors: Study Protocol for a Prospective, Multicenter, Real Clinical Setting Study. Front Cardiovasc Med 2022; 9:931943. [PMID: 35958398 PMCID: PMC9361843 DOI: 10.3389/fcvm.2022.931943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe incidence of preeclampsia (PE) is about 2–8%, making it one of the leading causes of perinatal morbidity and maternal mortality in the world. Early prophylactic low dose administration (150 mg) of acetylsalicylic acid is associated with a significant reduction in the incidence of early-onset PE, intrauterine growth restriction (IUGR), and neonatal mean stay in the intensive care unit (ICU). Universal implementation of a first-trimester screening system including angiogenic and antiangiogenic markers [the Placental Growth Factor (PlGF) and/or soluble fms-like Tyrosine Kinase-1 (sFlt-1)] has shown a prediction rate of 90% for early-onset PE but entails a high financial cost. The aim of this study is to determine the predictive and preventive capacity of a universal PE first-trimester two-step sequential screening model, determining the PlGF only in patients previously classified as intermediate risk by means of a multivariate model based on resources already used in the standard pregnancy control, in a real clinical setting. We hypothesize that this screening model will achieve similar diagnostic performance as the universal determination of PlGF but at a lower economic cost.Methods and AnalysisThis is a prospective, multicentric, cohort study in a real-world clinical setting. Every singleton pregnancy will be recruited at the routine first pregnancy visit. In a first step, the first-trimester risk of PE will be calculated using a multivariate Gaussian distribution model, based on medical history, mean blood pressure, Pregnancy-Associated Plasma Protein A (PAPP-A), and Uterine Artery Doppler Pulsatility Index (UTPI). Patients will be classified into three risk groups for PE: (1) risk ≥ 1/50, high-risk with no further testing (blinded PlGF); (2) risk between 1/51 and 1/500, medium-risk requiring further testing; and (3) risk ≤ 1/501, low-risk with no further testing. In a second step, the PlGF will only be determined in those patients classified as intermediate risk after this first step, and then reclassified into high- or low-risk groups. Prophylactic administration of aspirin (150 mg/day) will be prescribed only in high risk patients. As a secondary objective, sFlt-1 values will be blindly determined in patients with high and intermediate risk to assess its potential performance in the screening for PE.Ethics and DisseminationThe study will be conducted in accordance with the principles of Good Clinical Practice. This study is approved by the Aragon Research Ethics Committee (CEICA) on 3 July 2020 (15/2020).Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT04767438.
Collapse
Affiliation(s)
- Cristina Trilla
- Obstetrics and Gynecology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau–IIB Sant Pau, Barcelona, Spain
| | - Cristina Luna
- Obstetrics Department, Aragon Institute of Health Research (IIS Aragon), Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Silvia De León Socorro
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular, Materno Infantil, Las Palmas, Spain
| | - Leire Rodriguez
- Department of Obstetrics and Gynecology, Biocruces Bizkaia Health Research Institute, Osakidetza, University of the Basque Country, Cruces University Hospital, Bilbao, Spain
| | - Aina Ruiz-Romero
- Department of Obstetrics and Gynaecology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Josefina Mora Brugués
- Biochemistry Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Taysa Benítez Delgado
- Biochemistry Department, Complejo Hospitalario Universitario Insular, Materno Infantil, Las Palmas, Spain
| | - Marta Fabre
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
- Biochemistry Department, Aragon Institute of Health Research (IIS Aragon), Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Alicia Martin Martínez
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular, Materno Infantil, Las Palmas, Spain
| | - Sara Ruiz-Martinez
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
- Obstetrics Department, Aragon Institute of Health Research (IIS Aragon), Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Elisa Llurba
- Obstetrics and Gynecology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Biomèdica Sant Pau–IIB Sant Pau, Barcelona, Spain
| | - Daniel Oros
- Red RICORS “Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin”, RD21/0012/0001, Instituto de Salud Carlos III, Madrid, Spain
- Obstetrics Department, Aragon Institute of Health Research (IIS Aragon), Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- *Correspondence: Daniel Oros
| |
Collapse
|
2
|
Ruiz-Romero A, García-Costa L, Durban-Carrillo G, Bosch-Alcaraz A. Efficacy of a theoretical and practical programme to newly hired nursing personnel in a Paediatric Intensive Care Unit: A pilot study. Enferm Intensiva (Engl Ed) 2022; 33:141-150. [PMID: 35945110 DOI: 10.1016/j.enfie.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/05/2021] [Indexed: 06/15/2023]
Abstract
AIMS (1) to design a training programme for newly hired nursing personnel and (2) to determine self-perception and perceived stress before and after the theoretical and practical parts of the programme with high fidelity simulation activities. METHODS A pilot quasi-experimental pretest-posttest study without control group conducted in a Paediatric Intensive Care Unit from October 2018 to April 2019 was conducted. A newly hired nursing personnel training programme was first designed and delivered. Later, the participants' self-perception was assessed, as well as their perceived stress and grade of satisfaction using two different Likert scales. RESULTS A total of 20 newly hired nurses participated in the study, 90% (n = 18) were female with a median age of 25.5 ± 4.53 years. Higher scores were obtained in participants' self-perception before and after the theoretical training. Lower significant median scores of the participants' stress perception were found (6.9 ± 1.57 versus 5.6 ± 1.794). In the practical part of the programme, we obtained higher scores in all items, as well as lower median scores in stress perception (6.4 ± 1.73 versus 5.6 ± 1.93). CONCLUSIONS A theoretical and practical programme for newly hired nursing personnel in a Paediatric Intensive Care Unit improved participants' self-perception and reduced their perceived median scores in stress levels.
Collapse
Affiliation(s)
- A Ruiz-Romero
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - G Durban-Carrillo
- Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A Bosch-Alcaraz
- Unidad de Cuidados Intensivos Pediátricos Hospital Sant Joan de Déu, Departamento de Salud Pública, Salud Mental y Maternoinfantil, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain.
| |
Collapse
|
4
|
Sánchez O, Ruiz-Romero A, Domínguez C, Ferrer Q, Ribera I, Rodríguez-Sureda V, Alijotas J, Arévalo S, Carreras E, Cabero L, Llurba E. Brain angiogenic gene expression in fetuses with congenital heart disease. Ultrasound Obstet Gynecol 2018; 52:734-738. [PMID: 29205570 DOI: 10.1002/uog.18977] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/09/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess potential differences in the expression of antiangiogenic and angiogenic factors and of genes associated with chronic hypoxia in cerebral tissue of euploid fetuses with congenital heart disease (CHD) vs those without. METHODS Cerebral tissue was obtained from 15 fetuses with CHD and 12 control fetuses that had undergone termination of pregnancy. Expression profiles of the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFlt-1), the angiogenic vascular endothelial growth factor-A (VEGF-A) and placental growth factor (PlGF), and of genes associated with chronic hypoxia were determined by real-time polymerase chain reaction in tissue from the frontal cortex and the basal ganglia of the fetuses. RESULTS Expression of sFlt-1 was 48% higher in the frontal cortex (P = 0.0431) and 72% higher in the basal ganglia (P = 0.0369) of CHD fetuses compared with controls. The expression of VEGF-A was 60% higher (P = 0.0432) and that of hypoxia-inducible factor 2-alpha was 98% higher (P = 0.0456) in the basal ganglia of CHD fetuses compared with controls. No significant differences were observed between the two groups in the expression of PlGF and hypoxia-inducible factor 1-alpha. CONCLUSION An overall dysregulation of angiogenesis with a net balance towards an antiangiogenic environment was observed in the cerebral tissue of fetuses with CHD, suggesting that these fetuses may have an intrinsic angiogenic impairment that could contribute to impaired brain perfusion and abnormal neurological development later in life. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- O Sánchez
- Maternal and Child Health and Development Network (SAMID), RD16/0022/0015, Instituto de Salud Carlos III, Barcelona, Spain
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - A Ruiz-Romero
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Domínguez
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Q Ferrer
- Pediatric Cardiology Unit, Department of Pediatrics, Vall d'Hebron University Hospital, Barcelona, Spain
| | - I Ribera
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - V Rodríguez-Sureda
- Biochemistry and Molecular Biology Research Centre for Nanomedicine, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - J Alijotas
- Department of Internal Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Arévalo
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Cabero
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Llurba
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Research Institute (VHIR), SAMID Network, Vall d'Hebron University Hospital, Barcelona, Spain
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|