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Judgement beats all pre-eclampsia tests

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Clinical judgement is still the best way for nurses to identify those at risk of pre-eclampsia, according to a review.

None of the tests available to identify women at risk of the condition are effective, according to the National Institute for Health Research’s latest NHS health technology assessment.

But low-dose aspirin or calcium supplements may reduce risk of pre-eclampsia, said the authors, led by Kalid Khan, professor of obstetrics-gynaecology at Birmingham University.

They reviewed evidence on 27 different tests available, including urinary calcium/creatine ratio, haemoglobin, proteinuria/albuminuria and various Doppler techniques. They found none were effective enough to recommend for routine practice.

They also looked at 16 reviews of possible treatments that suggested regular low-dose aspirin could prevent pre-eclampsia and its negative effects on the baby. Calcium was also seen to reduce the risk of the condition but its impact on the baby was uncertain.

The authors said the most cost-effective approach to reducing pre-eclampsia risk was probably a ‘treat-all’ intervention, such as aspirin, applied to all mothers without testing. But they said it was too early to recommend this at present.

Janet Fyle, professional policy adviser for the RCM, said the best way to identify women at risk of pre-eclampsia remained clinical judgement. ‘Is the BMI over 34? Is their diastolic blood pressure over 80mmHg?’ she said. ‘The prediction comes from the risk factors.’

The Royal College of Obstetrics and Gynaecology is carrying out a scoping exercise on a future NICE guideline on pre-eclampsia but this is unlikely to be published before 2010.

However, latest NICE guidance on antenatal care backs up the review, stating that none of the available screening tests for pre-eclampsia has ‘satisfactory sensitivity and specificity’.

Health Technology Assessment (2008) 12: www.hta.ac.uk/1337

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