Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte
Objetivo: Evaluar el efecto sobre la incidencia de preeclampsia en una población gestante latina al aplicar entre semana 11-14+1 el denominado “doble test” descrito por Fetal Medicine Foundation (FMF) como prueba de tamizaje para predecir el riesgo de desarrollar esa patología Versus quienes se clas...
- Autores:
-
Linares Quintero, Andrés Fernando
- Tipo de recurso:
- Fecha de publicación:
- 2024
- Institución:
- Universidad Autónoma de Bucaramanga - UNAB
- Repositorio:
- Repositorio UNAB
- Idioma:
- spa
- OAI Identifier:
- oai:repository.unab.edu.co:20.500.12749/24701
- Acceso en línea:
- http://hdl.handle.net/20.500.12749/24701
- Palabra clave:
- Prediction preeclampsia
Uterine artery doppler
Gynecology
Obstetrics
Medical sciences
Public health
Obstetric emergencies
Pregnancy (Complications)
Ginecología
Obstetricia
Ciencias médicas
Salud pública
Urgencias obstétricas
Embarazo (Complicaciones)
Preeclampsia
Prediccion preeclampsia
Doppler de arterias uterinas
- Rights
- License
- http://creativecommons.org/licenses/by-nc-nd/2.5/co/
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| dc.title.spa.fl_str_mv |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte |
| dc.title.translated.spa.fl_str_mv |
Evaluation of the effect on the incidence of preeclampsia of combined screening in weeks 11-14 in a mid-level institution, a cohort study |
| title |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte |
| spellingShingle |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte Prediction preeclampsia Uterine artery doppler Gynecology Obstetrics Medical sciences Public health Obstetric emergencies Pregnancy (Complications) Ginecología Obstetricia Ciencias médicas Salud pública Urgencias obstétricas Embarazo (Complicaciones) Preeclampsia Prediccion preeclampsia Doppler de arterias uterinas |
| title_short |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte |
| title_full |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte |
| title_fullStr |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte |
| title_full_unstemmed |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte |
| title_sort |
Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorte |
| dc.creator.fl_str_mv |
Linares Quintero, Andrés Fernando |
| dc.contributor.advisor.none.fl_str_mv |
Quintero Roa, Eliana Maribel Ochoa Vera, Miguel Enrique |
| dc.contributor.author.none.fl_str_mv |
Linares Quintero, Andrés Fernando |
| dc.contributor.cvlac.spa.fl_str_mv |
Quintero Roa, Eliana Maribel [0000802689] Ochoa Vera, Miguel Enrique [898465] |
| dc.contributor.orcid.spa.fl_str_mv |
Quintero Roa, Eliana Maribel [0000-0002-4355-384X] Ochoa Vera, Miguel Enrique [0000-0002-4552-3388] |
| dc.contributor.scopus.spa.fl_str_mv |
Quintero Roa, Eliana Maribel [6507641217] Ochoa Vera, Miguel Enrique [36987156500] |
| dc.contributor.researchgate.spa.fl_str_mv |
Quintero Roa, Eliana Maribel [Eliana_Quintero2] Ochoa Vera, Miguel Enrique [Miguel_Ochoa7] |
| dc.contributor.researchgroup.spa.fl_str_mv |
Semilleros de Investigación UNAB |
| dc.contributor.apolounab.spa.fl_str_mv |
Quintero Roa, Eliana Maribel [eliana-maribel-quintero-roa] Ochoa Vera, Miguel Enrique [miguel-enrique-ochoa-vera] |
| dc.subject.keywords.spa.fl_str_mv |
Prediction preeclampsia Uterine artery doppler Gynecology Obstetrics Medical sciences Public health Obstetric emergencies Pregnancy (Complications) |
| topic |
Prediction preeclampsia Uterine artery doppler Gynecology Obstetrics Medical sciences Public health Obstetric emergencies Pregnancy (Complications) Ginecología Obstetricia Ciencias médicas Salud pública Urgencias obstétricas Embarazo (Complicaciones) Preeclampsia Prediccion preeclampsia Doppler de arterias uterinas |
| dc.subject.lemb.spa.fl_str_mv |
Ginecología Obstetricia Ciencias médicas Salud pública Urgencias obstétricas Embarazo (Complicaciones) |
| dc.subject.proposal.spa.fl_str_mv |
Preeclampsia Prediccion preeclampsia Doppler de arterias uterinas |
| description |
Objetivo: Evaluar el efecto sobre la incidencia de preeclampsia en una población gestante latina al aplicar entre semana 11-14+1 el denominado “doble test” descrito por Fetal Medicine Foundation (FMF) como prueba de tamizaje para predecir el riesgo de desarrollar esa patología Versus quienes se clasificaron según la Guía de práctica Clínica del Ministerio de Salud de Colombia. Materiales y métodos: En un estudio de Cohorte ambispectiva, se invitaron a participar todas aquellas gestantes que se realizaron una ecografía obstétrica en las instalaciones adscritas al Instituto de Salud de Bucaramanga (ISABU), cuando al momento de realizar la ecografía cursaban con embarazos de entre 11 y 14 semanas + 1 días de gestación durante el período de tiempo comprendido entre el 1 de abril de 2019 hasta el 28 de diciembre de 2023. Se utilizó el modelo basado en el teorema de Bayes de la Fetal Medicine Foundation para calcular el riesgo específico de cada paciente de desarrollar preeclampsia en <37 semanas de gestación (preeclampsia pretérmino) y en cualquier gestación (todas las preeclampsias) en cada participante. A las pacientes correspondientes a la cohorte de tamizaje según la Guía NICE el ultrasonido de semana 11-14 se lo realizó un gineco-obstetra capacitado en la realización de ultrasonido obstétrico de rutina. Se recogieron datos como presión arterial media, datos sociodemográficos y se realizó el cálculo del riesgo de la aplicación de la Fetal Medicine Foundation para el grupo expuesto al cribado combinado, cualquier paciente con un resultado de alto riesgo fue enviada al servicio de Urgencias. En todos los casos se contactó a la paciente 22 semanas después de la realización de la ecografía (para indagar sobre preeclampsia temprana) y posteriormente a las 30 semanas para indagar acerca pre-eclampsia tardía o puerperal y sobre otras variables de desenlace (Óbito fetal, código rojo, ingreso a UCI materna o neonatal, etc); Con la recolección de los datos completa, se realizó un análisis univariado, bivariado y multivariado. Resultados: Se reclutaron 343 participantes de las cuales cincuenta y cinco (55) se perdieron durante el seguimiento, de manera tal que el análisis final se realizó con la 288 (86,75%). El algoritmo de la FMF tuvo una sensibilidad del 66.7% (IC 29.9%- 92.5%) una especificidad de 88.9% (IC 80.5%-94.5%) Curva ROC 0.77 (IC 0.61- 0.944) Likelihood ratio (+) 6 (IC 2.85-12.6) Likelihood ratio (-) 0.375 (IC 0.148-0.148) OR 16 (IC 3.72-68.2) VPP 37.5% (IC 15.2-64.6) y VPN 96.4% (IC 89.8-99.2), OR=16. El algoritmo del Ministerio de salud tuvo una sensibilidad del 55.6% (IC 21.2%-86.3%) una especificidad de 82.2% (IC 72.7-89.5%) Curva ROC 0.689 (IC1,85-29.9) Likelihood ratio (+) 3.13 (IC 1.71-5,82) Likelihood ratio (-) 0.541 (IC 0.167- 1.07) OR 5.78 (IC 1.85-29.9) VPP 23.8% (IC 9.36-45.1) y VPN 94.9% (IC 88.6-92.2). La curva ROC encontró un área bajo la curva (AUC) FMF y Ministerio de Salud de 0.77 y 0.68 respectivamente, con una diferencia estadísticamente significativa p < 0.01. No hubo concordancia en 9 observaciones entre FMF vs Ministerio de Salud Control Prenatal. Se encontró que variables como nuliparidad, abortos, antecedente familiar de preeclampsia, preeclampsia en embarazo anterior, existencia de alguna enfermedad como diabetes I y II, hipertensión crónica, LES y Síndrome antifosfolípidos e IMC >30 son factores de riesgo para PE en nuestra población. Conclusión: En mujeres latinas con embarazo único, asintomáticas, el modelo competitivo de riesgos basado en el Teorema de Bayes de Fetal Medicine Foundation que incluye características maternas y marcadores biofísicos como la toma de presión arterial media y el índice de Pulsatilidad de la Arteria Uterina tiene mayor sensibilidad, especificidad y tasa de predicción de preeclampsia que otras combinaciones que excluyen el Doppler de la arteria uterina. También hemos demostrado que el modelo de predicción de la Fetal Medicine Foundation se puede implementar como parte de la atención prenatal de rutina mediante el uso de la infraestructura existente de atención prenatal. |
| publishDate |
2024 |
| dc.date.accessioned.none.fl_str_mv |
2024-05-21T14:29:36Z |
| dc.date.available.none.fl_str_mv |
2024-05-21T14:29:36Z |
| dc.date.issued.none.fl_str_mv |
2024-05-10 |
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info:eu-repo/semantics/masterThesis |
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Tesis |
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instname:Universidad Autónoma de Bucaramanga - UNAB reponame:Repositorio Institucional UNAB repourl:https://repository.unab.edu.co |
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spa |
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Neonatal outcome of pregnancies complicated by hypertensive disorders between 34 and 37 weeks of gestation: A 7 year retrospective analysis of a national registry. Am J Obstet Gynecol. 2011;205(6):540.e1-540.e7. Stratta P, Canavese C, Piccoli G, Todros T, Benedetto C. Early prediction of pre-eclampsia by measurement of kallikrein and creatinine on a random urine sample. BJOG. 1997;104(6):759–60. P. Vaillant E. David I. Constant. Validity in Nuliparas of Increased B-Human Chorionic Gonadotrophin at Mid-Term for Predciting Pregnancy-Induced Hypertension Complicated with Proteinuria and Intrauterin Growth Retardation. Nephron. 1996;557–63. Suarez VR, Trelles JG, Miyahira JM. Urinary calcium in asymptomatic primigravidas who later developed preeclampsia. Obstetrics and Gynecology. 1996;87(1):79–82. Broughton Pipkin F, Sharif J, Lal S. Predicting high blood pressure in pregnancy: A multivariate approach. J Hypertens. 1998;16(2):221–9. Gaiser R. Circulating Angiogenic Factors and the Risk of Preeclampsia. Survey of Anesthesiology. 2005;49(1):14–5. De Kat AC, Hirst J, Woodward M, Kennedy S, Peters SA. Prediction models for preeclampsia: A systematic review. Pregnancy Hypertens. 2019;16(March):48–66. Townsend R, Khalil A, Premakumar Y, Allotey J, Snell KIE, Chan C, et al. Prediction of pre-eclampsia: review of reviews. Vol. 54, Ultrasound in Obstetrics and Gynecology. John Wiley and Sons Ltd; 2019. p. 16–27. Martin AM, Bindra R, Curcio P, Cicero S, Nicolaides KH. Screening for pre- eclampsia and fetal growth restriction by uterine artery Doppler at 11-14 weeks of gestation. Ultrasound in Obstetrics and Gynecology. 2001;18(6):583–6. Azzaz AMSES, Cardoso RT. Antenatal care bookin during pregnancy and its effect on maternal and fetal outcomes. Lokken EM, Mathur A, Bunge KE, Fairlie L, Makanani B, Beigi R, et al. Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy. Vol. 3, Frontiers in Reproductive Health. Frontiers Media SA; 2021. Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. Pre- eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121 Suppl 1:14–24. de Freitas Leite J, Rago Lobo GA, Nowak PM, Antunes IR, Araujo Júnior E, da Silva Pares DB. Prediction of preeclampsia in the first trimester of pregnancy using maternal characteristics, mean arterial pressure, and uterine artery Doppler data in a Brazilian population. Obstet Gynecol Sci. 2019;62(6):391–6. Stubert J, Hinz B, Berger R. The Role of Acetylsalicylic Acid in the Prevention of Pre-Eclampsia, Fetal Growth Restriction, and Preterm Birth. Dtsch Arztebl Int. 2023 Sep 15;120(37):617–26. Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Vol. 226, American Journal of Obstetrics and Gynecology. Elsevier Inc.; 2022. p. S1108–19. Yi Jiang TP, Chen Z, Chen Y, Wei L, Gao P, Zhang J, et al. T a g g e d H 1 Low-dose asprin use during pregnancy may be a potential risk for postpartum hemorrhage and increased blood loss: a systematic review and meta-analysisT a g g e d E n d Systematic Review. Am J Obstet Gynecol MFM [Internet]. 2023;5:100878. Available from: http://dx.doi.org/10.1016/j.ajogmf.2023.100878 |
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Quintero Roa, Eliana Maribel9550cd86-659f-4c86-b86c-080b018199beOchoa Vera, Miguel Enriqueb2f66b1f-7691-4abf-a110-466c07955478Linares Quintero, Andrés Fernandocf745667-82df-4d51-8ab8-e51a96d3aadaQuintero Roa, Eliana Maribel [0000802689]Ochoa Vera, Miguel Enrique [898465]Quintero Roa, Eliana Maribel [0000-0002-4355-384X]Ochoa Vera, Miguel Enrique [0000-0002-4552-3388]Quintero Roa, Eliana Maribel [6507641217]Ochoa Vera, Miguel Enrique [36987156500]Quintero Roa, Eliana Maribel [Eliana_Quintero2]Ochoa Vera, Miguel Enrique [Miguel_Ochoa7]Semilleros de Investigación UNABQuintero Roa, Eliana Maribel [eliana-maribel-quintero-roa]Ochoa Vera, Miguel Enrique [miguel-enrique-ochoa-vera]Bucaramanga (Santander, Colombia)2021-2023UNAB Campus Bucaramanga2024-05-21T14:29:36Z2024-05-21T14:29:36Z2024-05-10http://hdl.handle.net/20.500.12749/24701instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coObjetivo: Evaluar el efecto sobre la incidencia de preeclampsia en una población gestante latina al aplicar entre semana 11-14+1 el denominado “doble test” descrito por Fetal Medicine Foundation (FMF) como prueba de tamizaje para predecir el riesgo de desarrollar esa patología Versus quienes se clasificaron según la Guía de práctica Clínica del Ministerio de Salud de Colombia. Materiales y métodos: En un estudio de Cohorte ambispectiva, se invitaron a participar todas aquellas gestantes que se realizaron una ecografía obstétrica en las instalaciones adscritas al Instituto de Salud de Bucaramanga (ISABU), cuando al momento de realizar la ecografía cursaban con embarazos de entre 11 y 14 semanas + 1 días de gestación durante el período de tiempo comprendido entre el 1 de abril de 2019 hasta el 28 de diciembre de 2023. Se utilizó el modelo basado en el teorema de Bayes de la Fetal Medicine Foundation para calcular el riesgo específico de cada paciente de desarrollar preeclampsia en <37 semanas de gestación (preeclampsia pretérmino) y en cualquier gestación (todas las preeclampsias) en cada participante. A las pacientes correspondientes a la cohorte de tamizaje según la Guía NICE el ultrasonido de semana 11-14 se lo realizó un gineco-obstetra capacitado en la realización de ultrasonido obstétrico de rutina. Se recogieron datos como presión arterial media, datos sociodemográficos y se realizó el cálculo del riesgo de la aplicación de la Fetal Medicine Foundation para el grupo expuesto al cribado combinado, cualquier paciente con un resultado de alto riesgo fue enviada al servicio de Urgencias. En todos los casos se contactó a la paciente 22 semanas después de la realización de la ecografía (para indagar sobre preeclampsia temprana) y posteriormente a las 30 semanas para indagar acerca pre-eclampsia tardía o puerperal y sobre otras variables de desenlace (Óbito fetal, código rojo, ingreso a UCI materna o neonatal, etc); Con la recolección de los datos completa, se realizó un análisis univariado, bivariado y multivariado. Resultados: Se reclutaron 343 participantes de las cuales cincuenta y cinco (55) se perdieron durante el seguimiento, de manera tal que el análisis final se realizó con la 288 (86,75%). El algoritmo de la FMF tuvo una sensibilidad del 66.7% (IC 29.9%- 92.5%) una especificidad de 88.9% (IC 80.5%-94.5%) Curva ROC 0.77 (IC 0.61- 0.944) Likelihood ratio (+) 6 (IC 2.85-12.6) Likelihood ratio (-) 0.375 (IC 0.148-0.148) OR 16 (IC 3.72-68.2) VPP 37.5% (IC 15.2-64.6) y VPN 96.4% (IC 89.8-99.2), OR=16. El algoritmo del Ministerio de salud tuvo una sensibilidad del 55.6% (IC 21.2%-86.3%) una especificidad de 82.2% (IC 72.7-89.5%) Curva ROC 0.689 (IC1,85-29.9) Likelihood ratio (+) 3.13 (IC 1.71-5,82) Likelihood ratio (-) 0.541 (IC 0.167- 1.07) OR 5.78 (IC 1.85-29.9) VPP 23.8% (IC 9.36-45.1) y VPN 94.9% (IC 88.6-92.2). La curva ROC encontró un área bajo la curva (AUC) FMF y Ministerio de Salud de 0.77 y 0.68 respectivamente, con una diferencia estadísticamente significativa p < 0.01. No hubo concordancia en 9 observaciones entre FMF vs Ministerio de Salud Control Prenatal. Se encontró que variables como nuliparidad, abortos, antecedente familiar de preeclampsia, preeclampsia en embarazo anterior, existencia de alguna enfermedad como diabetes I y II, hipertensión crónica, LES y Síndrome antifosfolípidos e IMC >30 son factores de riesgo para PE en nuestra población. Conclusión: En mujeres latinas con embarazo único, asintomáticas, el modelo competitivo de riesgos basado en el Teorema de Bayes de Fetal Medicine Foundation que incluye características maternas y marcadores biofísicos como la toma de presión arterial media y el índice de Pulsatilidad de la Arteria Uterina tiene mayor sensibilidad, especificidad y tasa de predicción de preeclampsia que otras combinaciones que excluyen el Doppler de la arteria uterina. También hemos demostrado que el modelo de predicción de la Fetal Medicine Foundation se puede implementar como parte de la atención prenatal de rutina mediante el uso de la infraestructura existente de atención prenatal.1. TÍTULO DEL PROYECTO ........................................................................................................... 4 2. RESUMEN DEL PROYECTO ...................................................................................................... 4 3. DESCRIPCIÓN DEL PROYECTO ............................................................................................... 6 3.1 Planteamiento del problema ...................................................................................................... 6 3.2 Justificación ...................................................................................................................... 12 4. MARCO TEÓRICO ........................................................................................................................ 18 4.1 Definición de Preeclampsia y Epidemiología ........................................................................... 18 4.2 Fisiopatología de la preeclampsia y Biomarcadores Moleculares ........................................... 21 4.3 Predicción de preeclampsia ..................................................................................................... 25 4.3.1 Predicción basada en Factores de riesgo ......................................................................... 25 4.3.2 Predicción basada en Doppler de Arterias Uterinas. ........................................................ 27 4.3.3 Predicción basada en Biomarcadores moleculares. ......................................................... 29 4.3.4 Predicción basada en Modelo de Fundación de Medicina Fetal. ..................................... 30 4.4 Prevención de Preeclampsia ....................................................................................................33 4.5 Manejo de la preeclampsia ...................................................................................................... 35 5. ESTADO DEL ARTE .................................................................................................................. 37 6. OBJETIVOS ................................................................................................................................... 45 6.1 Objetivo general ....................................................................................................................... 45 6.2 Objetivos específicos ............................................................................................................... 45 7. METODOLOGÍA ........................................................................................................................ 45 7.1 Tipo de Estudio ........................................................................................................................ 45 7.2 Población ................................................................................................................................. 45 7.3 Muestra .................................................................................................................................... 46 7.4 Muestreo .................................................................................................................................. 46 7.5 Criterios de selección ............................................................................................................... 47 7.5.1 Criterios de inclusión ......................................................................................................... 47 7.5.2 Criterios de exclusión ........................................................................................................ 47 7.6 Variables del estudio ........................................................................................................ 47 7.7 Procedimiento del estudio/Obtención de la información ...........................................................48 7.8 Muestreo .................................................................................................................................. 51 7.8.1 Cálculo tamaño muestral .................................................................................................. 51 7.8.2 Instrumento de medición................................................................................................... 51 7.8.3 Plan de análisis ................................................................................................................. 51 8. RESULTADOS........................................................................................................................... 52 8.1 Análisis Univariado .................................................................................................................. 53 8.3 Análisis multivariado ................................................................................................................ 67 9. DISCUSIÓN ............................................................................................................................... 68 10. LIMITACIONES Y FORTALEZAS ........................................................................................ 76 11. CONCLUSIONES ................................................................................................................. 77 12. CONSIDERACIONES ÉTICAS............................................................................................. 77 13. ANEXOS ............................................................................................................................... 79 ANEXO 1. Encuesta y procedimientos a realizar en el cribado combinado semana 11-14 de la Fundación de Medicina Fetal ......................................................................................................... 79 ANEXO 2 ....................................................................................................................................... 80 2.1 Encuesta de Primer contacto a Pacientes ........................................................................... 80 2.2 Encuesta seguimiento 30 semanas posterior a la realización del Cribado combinado Vs Control Prenatal ......................................................................................................................... 82 2.3 Encuesta seguimiento 37 semanas posterior a la realización del Cribado combinado Vs Control Prenatal ......................................................................................................................... 84 ANEXO 3: CONSENTIMIENTO INFORMADO PARA CONTESTAR LA ENCUESTA DEL PROYECTO DE INVESTIGACIÓN ............................................................................................... 86 ANEXO 4: ASENTIMIENTO INFORMADO PARA PACIENTE MENOR DE 18 AÑOS PARA PARTICIPACIÓN EN EL PROYECTO DE INVESTIGACIÓN. ANEXO 5: Propuesta de seguimiento a pacientes. ....................................................................... 91 14. BIBLIOGRAFÍA ............................................................................................................................ 92EspecializaciónObjective: To evaluate the effect on the incidence of preeclampsia in a Latin pregnant population by applying the so-called “double test” described by the Fetal Medicine Foundation (FMF) between weeks 11-14+1 as a screening test to predict the risk of developing this pathology. Versus those who were classified according to the Clinical Practice Guide of the Colombian Ministry of Health. Materials and methods: In an ambispective cohort study, all pregnant women who underwent an obstetric ultrasound in the facilities attached to the Bucaramanga Health Institute (ISABU) were invited to participate, when at the time of the ultrasound they were pregnant between 11 and 14 weeks + 1 day of gestation during the time period from April 1, 2019 to December 28, 2023. The model based on Bayes theorem of the Fetal Medicine Foundation was used to calculate the specific risk of each patient from developing preeclampsia at <37 weeks of gestation (preterm preeclampsia) and at any gestation (all preeclampsia) in each participant. For the patients corresponding to the screening cohort according to the NICE Guide, the ultrasound from week 11-14 was performed by an obstetrician-gynecologist trained in performing routine obstetric ultrasound. Data such as mean arterial pressure, sociodemographic data were collected and risk calculation was performed using the Fetal Medicine Foundation application for the group exposed to combined screening. Any patient with a high-risk result was sent to the Emergency Department. In all cases the patient was contacted 22 weeks after performing the ultrasound (to inquire about early preeclampsia) and later at 30 weeks to inquire about late or puerperal pre-eclampsia and other outcome variables (fetal death, code red, admission to maternal or neonatal ICU , etc); With data collection complete, a univariate, bivariate and multivariate analysis was performed. Results: 343 participants were recruited, of which fifty-five (55) were lost to follow-up, so that the final analysis was performed with 288 (86.75%). The FMF algorithm had a sensitivity of 66.7% (CI 29.9%- 92.5%) and a specificity of 88.9% (CI 80.5%-94.5%) ROC curve 0.77 (CI 0.61- 0.944) Likelihood ratio (+) 6 (CI 2.85-12.6) Likelihood ratio (-) 0.375 (CI 0.148-0.148) OR 16 (CI 3.72-68.2) PPV 37.5% (CI 15.2-64.6) and NPV 96.4% (CI 89.8-99.2), OR=16. The Ministry of Health algorithm had a sensitivity of 55.6% (CI 21.2%-86.3%) and a specificity of 82.2% (CI 72.7-89.5%) ROC curve 0.689 (CI 1.85-29.9) Likelihood ratio (+) 3.13 (CI 1.71-5.82) Likelihood ratio (-) 0.541 (CI 0.167- 1.07) OR 5.78 (CI 1.85-29.9) PPV 23.8% (CI 9.36-45.1) and NPV 94.9% (CI 88.6-92.2). The ROC curve found an area under the curve (AUC) FMF and Ministry of Health of 0.77 and 0.68 respectively, with a statistically significant difference p < 0.01. There was no agreement in 9 observations between FMF vs Ministry of Health Prenatal Control. It was found that variables such as nulliparity, abortions, family history of preeclampsia, preeclampsia in a previous pregnancy, existence of a disease such as diabetes I and II, chronic hypertension, SLE and antiphospholipid syndrome and BMI >30 are risk factors for PE in our population. Conclusion: In asymptomatic Latina women with a singleton pregnancy, the competitive risk model based on the Bayes Theorem of the Fetal Medicine Foundation that includes maternal characteristics and biophysical markers such as mean arterial pressure measurement and the Uterine Artery Pulsatility Index has higher sensitivity, specificity and prediction rate of preeclampsia than other combinations that exclude uterine artery Doppler. We have also demonstrated that the Fetal Medicine Foundation's prediction model can be implemented as part of routine prenatal care by using existing prenatal care infrastructure.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Evaluación del efecto en la incidencia de preeclampsia del cribado combinado en semana 11-14 en una institución de nivel medio, un estudio de cohorteEvaluation of the effect on the incidence of preeclampsia of combined screening in weeks 11-14 in a mid-level institution, a cohort studyEspecialista en Ginecología y ObstetriciaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Ginecología y Obstetriciainfo:eu-repo/semantics/masterThesisTesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/redcol/resource_type/TMPrediction preeclampsiaUterine artery dopplerGynecologyObstetricsMedical sciencesPublic healthObstetric emergenciesPregnancy (Complications)GinecologíaObstetriciaCiencias médicasSalud públicaUrgencias obstétricasEmbarazo (Complicaciones)PreeclampsiaPrediccion preeclampsiaDoppler de arterias uterinasChaemsaithong P, Sahota DS, Poon LC. First trimester preeclampsia screening and prediction. Vol. 226, American Journal of Obstetrics and Gynecology. Elsevier Inc.; 2022. p. S1071-S1097.e2.Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367(9516):1066–74.Mandal R. Reality of Preeclampsia in Colombian Pregnant Women. Open Access Journal of Gynecology. 2016;1(1):1–3.Webster K., Fishbum S., Maresh M., Findlay S.C. Hypertension in pregnancy: diagnosis and management NICE guideline [Internet]. 2019. Available from: www.nice.org.uk/guidance/ng133Webster K, Fishburn S, Maresh M, Findlay SC, Chappell LC. Diagnosis and management of hypertension in pregnancy: Summary of updated NICE guidance. The BMJ [Internet]. 2019;366(September):1–8. Available from: http://dx.doi.org/doi:10.1136/bmj.l5119Tan MY, Syngelaki A, Poon LC, Rolnik DL, O’Gorman N, Delgado JL, et al. Screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks’ gestation. 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