现实世界的实施和适应当地设置的早期妊娠子痫前期筛查在意大利:一个系统的回顾

S. Amodeo, G. Bonavina, A. Seidenari, P. Cavoretto, A. Farina
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摘要

背景:子痫前期(PE)是一种妊娠多系统疾病,是孕产妇和围产儿发病率和死亡率的主要原因。早期识别妊娠发生PE的风险对于实施预防策略至关重要。妊娠早期PE筛查的有效性得到了一些指导方针的广泛认可和支持,但不幸的是,在当地环境中实际实施这种做法仍然很困难。方法:我们对文献进行了系统回顾,以了解阻碍意大利PE筛查程序实施的关键问题。所有关于意大利人群妊娠早期PE筛查的研究均符合纳入条件。提取并定性分析了与意大利PE筛查实施相关的关键概念。结果:9篇文章入选。在意大利缺乏关于PE筛查主题的证据。发现的主要关键问题包括卫生保健人员的教育、超声医师的培训、生化标记物的经济覆盖以及基于人口特征的算法调整。结论:确定并适应当地环境和人口特征的具体方案对于在意大利成功实施早期PE筛查至关重要。这一过程有可能改善妊娠结局,并节省宝贵的卫生保健资源,特别是在COVID-19时代稀缺的资源。迫切需要对特定的当地人群进行研究,重点关注能够最大限度地利用PE筛查的细微细节。这一行动可能会加强PE筛查的实施,减少围产期和孕产妇并发症的负担和成本。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Real-world implementation and adaptation to local settings of first trimester preeclampsia screening in Italy: a systematic review
Background: Preeclampsia (PE) is a multisystem disease of pregnancy representing a major cause of maternal and perinatal morbidity and mortality. Early identification of pregnancies at risk of developing PE is crucial for implementing preventive strategies. The effectiveness of PE screening in the first trimester is widely recognized and endorsed by several guidelines, but unfortunately real-world implementation of this practice within local settings remains difficult. Methods: We performed a systematic review of the literature to understand the critical issues hampering the implementation of PE screening procedures in Italy. All studies on first trimester PE screening in the Italian population were eligible for inclusion. Key-concepts relevant for implementation of PE screening in Italy were extracted and analysed qualitatively. Results: Nine articles were selected and included. Lack of evidence concerning the topic of PE screening in Italy was shown. Major critical issues found encompassed healthcare personnel education, training of sonographers, economic coverage for biochemical markers and adjustment of algorithms based on population characteristics. Conclusions: Identification and adaptation of specific protocols to local settings and population characteristics is critical for successful implementation of early PE screening in Italy. This process has the potential to improve pregnancy outcomes and to save valuable health-care resources, particularly scarce in the COVID-19 era. There is an urgent need for research studies on specific local populations focussing on subtle details capable of maximizing PE screening uptake. This action will likely potentiate PE screening implementation reducing the burden and the cost of perinatal and maternal complications.
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