Not orderable

1T Pre-Term Preeclampsia Screen

Synonyms

  • 1T PRE-TERM PREECLAMPSIA SCREEN
  • 1TPTPE
  • LAB4215

Cerner Name

1T Pre-Term Preeclampsia Screen

Clinical Info

1T Pre-Term Preeclampsia Screen is a first trimester screening test used to identify patients at risk of developing preeclampsia prior to 37 weeks' gestation. The test incorporates the maternal serum markers PAPP-A and PlGF, ultrasound evaluation of uterine artery pulsatility index (UtAD-PI) and measurement of mean arterial pressure. An increased risk result means that close monitoring (blood pressure, proteinuria etc.) and low dose aspirin should be considered.

Note: For second and third trimester sFLT-1/PlGF ratio please see 2T3TPE (2nd 3rd Trimester Preeclampsia).

Specimen Sources

Blood, Arterial Blood, Capillary Blood, Central Line Blood, Venous

Specimen Types

Blood

Specimen Volume

3 mL serum ( 0.5 mL min)

Container

Gold Top Tube 

Collection Instructions

Collection Instructions Collect blood by venipuncture, allow it to clot and separate the serum by centrifugation. 
Specimen Volume: 3 ml serum (0.5 ml Min)
Specimen Rejection Criteria:  Incorrect tube type
                                                Insufficient volume
                                                Fetal/maternal blood contamination
                                                Out of gestational age range
Specimen draw is from 10.0 to 13.6 weeks gestation and must be before CVS or amniocentesis. 
UtAD-PI must be assessed when the CRL is 45-84mm.   The Sonographer must be credentialed by the Fetal Medicine Foundation and the certification number must be provided.
Special Instructions:
The following Ask on Order Entry (AOE) patient information must be provided:
AOE1: Maternal Weight 
AOE2: Race 
AOE3: Estimated Date of Delivery (EDD) 
AOE4: Current Smoker 
AOE5: IVF 
AOE6: Ultrasound Date 
AOE7: Sonographer (ID) 
AOE8: Sonographer Supervisor MD (ID) 
AOE9: CRL 
AOE10: BP Date 
AOE11: Systolic BP Left Arm 1 
AOE12: Diastolic BP Left Arm 1 
AOE13: Systolic BP Right Arm 1 
AOE14: Diastolic BP Right Arm 1 
AOE15: Systolic BP Left Arm 2 
AOE16: Diastolic BP Left Arm 2 
AOE17: Systolic BP Right Arm 2 
AOE18: Systolic BP Right Arm 2 
AOE19: UtAD-PI Left 
AOE20: UtAD-PI Right 
AOE21: Maternal Height 
AOE22: Obstetric History (Nulliparous, No Previous PE, Previous PE)
AOE23: Date of Delivery Last Pregnancy 
AOE24: Gestational Weeks at Delivery of Last Pregnancy 
AOE25: Gestational Days at Delivery of Last Pregnancy (0-6)
AOE26: Patient’s Mother with History of Preeclampsia 
AOE27: Chronic Hypertension 
AOE28: Diabetes Status 
AOE29: Systemic Lupus erythematosus 
AOE30: Anti-phospholipid Syndrome 
Complete information is necessary to interpret the test. Patient information may be provided to the laboratory using the Maternal Prenatal Screening request form (2006260603).  

Transport Instructions

Refrigerate prior to shipping for overnight delivery.
Transport Temperature: Ambient

Specimen Stability

6 days Room Temperature

Methodology

Methodology Time-Resolved Amplified Cryptate Emission (TRACE) 
This test was developed, and its performance characteristics determined by Northwell Health Laboratories. It has not been cleared or approved by the Food and Drug Administration. The methods and performance characteristics have been reviewed and approved by the New York State Department of Health.

Days Performed

Monday - Friday  TAT 1 - 2 Days

Performing Laboratories

Northwell Health Laboratories

CPT

PAPP-A – 84163
PlGF - 83520

PDM

251467

Results
Component Name Base Name Common Name External Name
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
CURRENT SMOKER CURSMOKER CURRENT SMOKER Current Smoker
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
MULTIPLE PREGNANCY STATUS MULPREGSTAT MULTIPLE PREGNANCY STATUS Multiple Pregnancy Status
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
MS RACE/ETHNICITY ETHNICITY MS RACE ETHNICITY
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
MS ESTIMATED DUE DATE EDUEDT MS ESTIMATED DUE DATE
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
MATERNAL WEIGHT, 2ND TRIMESTER MTWT MS MATERNAL WEIGHT MS Maternal Weight
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREV PREG WITH DOWN SYNDROME PREVPREGDOWN PREV PREG WITH DOWN SYNDROME Prev Preg with Down Syndrome
PREECLAMPSIA RISK CUTOFF PREECLAMPRC PREECLAMPSIA RISK CUTOFF Preeclampsia Risk Cutoff
PRETERM PREECLAMPSIA PREPREECLAMP PRETERM PREECLAMPSIA Preterm Preeclampsia
BEFORE SCREEN RISK PRETERM PREECLAMPSIA BSRPREECLAMP BEFORE SCREEN RISK PRETERM PREECLAMPSIA Before Screen Risk Preterm Preeclampsia
AFTER SCREEN RISK PRETERM PREECLAMPSIA ASRPREECLAMP AFTER SCREEN RISK PRETERM PREECLAMPSIA After Screen Risk Preterm Preeclampsia
PRETERM PREECLAMPSIA INTERPRETATION PREPREEINT PRETERM PREECLAMPSIA INTERPRETATION Preterm Preeclampsia Interpretation
PAPP-A VALUE PAPPAVAL PAPP A VALUE PAPP-A Concentration
PAPP-A MOM PAPPAMOM PAPP A MOM PAPP-A MoM
PAPP A PERCENTILE PAPPAPCT PAPP A PERCENTILE PAPP-A Percentile
PLGF PLGF PLGF PlGF Concentration
PLGF MOM PLGFMOM PLGF MOM PlGF MoM
PLGF PERCENTILE PLGFPCT PLGF PERCENTILE PlGF Percentile
1T MAP 1TMAP 1T MAP 1T MAP
MAP MOM MAPMOM MAP MOM MAP MoM
MAP PERCENTILE MAPPERCENT MAP PERCENTILE
UTAD-PI MEAN UTADPIMEAN UTAD PI MEAN UtAD-PI Mean
UTAD-PI MOM UTADPIMOM UTAD PI MOM UtAD-PI MoM
UTAD-PI PERCENTILE UTADPI UTAD-PI PERCENTILE
PREGNANCY INTERVAL PREGINT PREGNANCY INTERVAL Pregnancy Interval
GA AT U/A GESTAGE GA AT UA GA at U/A
GESTATIONAL AGE GESTAGE GESTATIONAL AGE Gestational Age
AGE AGE AGE
MS SONOGRAPHER SONOG MS SONOGRAPHER
SONOGRAPHER SUPERVISOR SONOG SONOGRAPHER SUPERVISOR Sonographer Supervisor
DATE COMPLETED DATECOMP DATE COMPLETED Ultrasound Date
MS CRL CRLSCAN MS CRL
MS CRL TWIN B CRLSCANTWINB MS CRL TWIN B
UTAD-PI LEFT UTAD UTAD-PI LEFT UtAD-PI Left
UTAD-PI RIGHT UTAD UTAD-PI RIGHT UtAD-PI Right
BP DATE BP BP DATE BP Date
SYSTOLIC BP LEFT ARM 1 SBP SYSTOLIC BP LEFT ARM 1 Systolic BP Left Arm 1
DIASTOLIC BP LEFT ARM 1 DBP DIASTOLIC BP LEFT ARM 1 Diastolic BP Left Arm 1
SYSTOLIC BP RIGHT ARM 1 SBP SYSTOLIC BP RIGHT ARM 1 Systolic BP Right Arm 1
DIASTOLIC BP RIGHT ARM 1 DBP DIASTOLIC BP RIGHT ARM 1 Diastolic BP Right Arm 1
SYSTOLIC BP LEFT ARM 2 SBP SYSTOLIC BP LEFT ARM 2 Systolic BP Left Arm 2
DIASTOLIC BP LEFT ARM 2 DBP DIASTOLIC BP LEFT ARM 2 Diastolic BP Left Arm 2
SYSTOLIC BP RIGHT ARM 2 SBP SYSTOLIC BP RIGHT ARM 2 Systolic BP Right Arm 2
DIASTOLIC BP RIGHT ARM 2 DBP DIASTOLIC BP RIGHT ARM 2 Diastolic BP Right Arm 2
MATERNAL HEIGHT (IN) HEIGHT MATERNAL HEIGHT (IN) Maternal Height (in)
DIABETES STATUS DM DIABETES STATUS Diabetes Status
CHRONIC HYPERTENSION HTN CHRONIC HYPERTENSION Chronic Hypertension
SYSTEMIC LUPUS ERYTHEMATOSUS SLE SYSTEMIC LUPUS ERYTHEMATOSUS Systemic Lupus erythematosus
ANTI-PHOSPHOLIPID SYNDROME APLS ANTI-PHOSPHOLIPID SYNDROME Anti-phospholipid Syndrome
MOTHER HIST OF PREECLAMPSIA PRECLMPHX MOTHER HIST OF PREECLAMPSIA Mother Hist of Preeclampsia
OBSTETRIC HISTORY OBHX OBSTETRIC HISTORY Obstetric History
EGG DONOR AGE AT RETRIEVAL EGGDONORAGE EGG DONOR AGE AT RETRIEVAL Egg Donor Age at Retrieval
MS CHORIONICITY CHORIONICITY MS CHORIONICITY
DATE OF DELIVERY LAST PREGNANCY DATEOFPREG DATE OF DELIVERY LAST PREGNANCY Date of Delivery Last Pregnancy
GEST WEEKS AT LAST PREG GESTWKS GEST WEEKS AT LAST PREG Gest Weeks At Last Preg
GEST DAYS AT DEL LAST PREG GESTDAYS GEST DAYS AT DEL LAST PREG Gest Days at Del Last Preg
GEN TEST INFORMATION GENTEST GEN TEST INFORMATION Disclaimer

Result Interpretation

Risk Calculation: 
Each marker level is converted into a multiple of the GA specific median (MoM) and is then adjusted as applicable based on the patient's race, weight, diabetic status, multiple pregnancy status, Egg Donor status, and smoking status.  Patient specific risks for pre-term preeclampsia are calculated following the competing risks approach developed by the Fetal Medicine Foundation (FMF) using Bayes theorem to combine the a priori risk from maternal characteristics and medical history with the results of the  biophysical and biochemical measurements.   This approach assumes that if the pregnancy was to continue indefinitely all women would eventually develop PE and whether they do so or not depends on competition between which comes first, delivery or the development of PE. This approach allows the estimation of the individual patient-specific risks of delivery with preeclampsia before 37 weeks gestational age. 

An interpretive risk report including the patient's marker levels, cut-off values and risk for pre-term preeclampsia will be provided.

Pre-Term Preeclampsia Interpretation:
The risk cut-off is set equal to 1/150.  This test may detect over 80% of cases destined to develop preeclampsia necessitating delivery prior to 37 weeks gestational age including over 90% of cases <34 weeks at an approximate 15% false positive rate.

Since the prior risk of twins is high, most twins will screen positive. Comparison of the after screening risk to the before screening risk may be of assistance in evaluating the pregnancy.

Test Follow Up: 
If the patient's risk is less than the cut-off risk the test is considered "Within Normal Range" and no further action is required. If the patient’s risk is greater than or equal to the cut-off risk the test is considered "Increased Risk". 

Patients at increased risk may be offered: 
1.    Education regarding the signs and symptoms of preeclampsia
2.    Increased monitoring including the option of home blood pressure monitoring
3.    Prophylactic low-dose aspirin starting prior to 16 weeks to reduce the risk of preeclampsia, IUGR and Preterm Delivery.

Upon receiving pre-term preeclampsia screening results, all information used in the risk calculation should be reviewed for accuracy (i.e., weight, diabetic status, gestational dating). If any information is incorrect, the laboratory should be contacted for recalculation of the estimated risks. ‘Within Range’ risk results typically do not warrant further evaluation. The screen results are dependent on accurate demographic information.  Inaccurate information can lead to significant alterations in the estimated risk. In particular, erroneous assessment of gestational age can result in false-positive or false-negative screen results. 

Disclaimers
This is a screening test, not a diagnostic test. A ‘Within Range’ risk result indicates low risk for the conditions screened but does not guarantee the absence of those conditions or other abnormalities. An ‘Increased Risk’ result indicates an increased risk for the condition screened but does not infer a definitive diagnosis. 

Cautions
Valid measurements of maternal serum markers cannot be made after CVS or amniocentesis. Triplets and higher order multiple pregnancies cannot be interpreted. In rare cases, some individuals can develop antibodies to mouse or other animal antibodies (often referred to as human anti-mouse antibodies [HAMA] or heterophile antibodies), which may cause interference in some immunoassays. Caution should be used in interpretation of results and the laboratory should be alerted if the result does not correlate with the clinical presentation.

Each center offering pre-term preeclampsia screening to patients should establish a standard screening protocol, which provides pre- and post-screening education and appropriate follow-up for ‘Increased Risk’ results.

Clinical References 
(1)  Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 2017;377: 613–22.\
(2)  Akolekar R, Syngelaki A, Poon L, Wright D, Nicolaides KH. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diagn Ther 2013;33: 8–15.
(3)  Rolnik DL, Wright D, Poon LCY, et al.  ASPRE trial: performance of screening for pre-term pre-eclampsia. Ultrasound Obstet Gynecol 2017;50:492–5.
(4)  Chaemsaithong P, Sahota DS, Poon LC.  First trimester preeclampsia screening and
prediction. Am J Obstet Gynecol. 2022 Feb;226(2S):S1071-S1097.e2.
(5)  Foster AB, Park, F, Hyett J.  Do first‐trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre‐term preeclampsia: A systematic review and meta‐analysis.  Prenatal Diagnosis. 2023;43:950–958.

Forms
Prenatal LAB4215 build edit