# First-Trimester Preeclampsia Screening During the COVID-19 Pandemic: A Quality Improvement Comparison of the National Institute for Health and Care Excellence (NICE) Guidelines vs. Simplified Fetal Medicine Foundation Algorithm

## TL;DR

This study compares two methods for early preeclampsia screening during the pandemic, finding the FMF method more effective than NICE guidelines.

## Contribution

The study evaluates and compares preeclampsia screening methods under pandemic conditions, highlighting the FMF algorithm's superior performance.

## Key findings

- The mini-combined FMF method showed 50% sensitivity and 89.9% specificity at a 1:100 cutoff for preeclampsia.
- An optimal 1:165.5 cutoff for the FMF method achieved 70.5% sensitivity and 80.9% specificity.
- NICE guidelines had lower sensitivity (22.7%) compared to the FMF method.

## Abstract

Objective: To evaluate the effectiveness of the National Institute for Health and Care Excellence (NICE) guidelines versus the mini-combined test for preeclampsia screening at 11-14 weeks of gestation, considering COVID-19 restrictions.

Methods: This study included women ≥18 years old with singleton pregnancies attending routine antenatal visits between May 1 and September 1, 2021. Data collected included maternal characteristics, medical history, uterine artery pulsatility index (PI), and pregnancy-associated plasma protein-A (PAPP-A) levels. Both NICE and Fetal Medicine Foundation (FMF) methods were used to classify high and low-risk cases.

Results: The mini-combined method showed 50% sensitivity and 89.9% specificity at a 1:100 cutoff for all preeclampsia cases. An optimal cutoff of 1:165.5 yielded 70.5% sensitivity and 80.9% specificity. NICE’s method demonstrated 22.7% sensitivity and 90.9% specificity.

Conclusion: The mini-combined screening method using the FMF algorithm outperforms the NICE method in preeclampsia screening. Implementing the full FMF method, including mean arterial pressure (MAP) and placental growth factor (PLGF), is recommended based on superior performance and international literature support.