A Time Study for the Analysis of the Potential for the Automated Stepwise Screening Program for Preeclampsia at Week 12 of Gestation

Preeclampsia (PE) is a hypertensive disorder of pregnancy, occurring in 2–8% of all pregnancies. PE can cause life-threatening conditions and result in adverse events for both mother and baby. The only treatment of the condition is delivery of the baby, which often leads to preterm delivery. It is shown that prophylactic treatment with aspirin from early pregnancy can prevent or delay severe preeclampsia in women with high risk of PE. Screening by a combination of maternal risk factors and biomarkers has been shown to identify up to 90% of women at risk of developing early-onset PE. The aim of this study was to investigate the time spent for each step in the screening program in the first-trimester screening program in week 12 as input for an analysis of the potential for the automated stepwise screening program. The time used for obtaining maternal risk factors (MF), mean arterial blood pressure (MAP), and uterine arterial pulsatility index (UtA-PI) was measured through observations and using dedicated timekeeper tablet apps. The study found that the mean duration for measuring the UtA-PI was 2.7 min ranging from 1.3–8.5 min, based on 39 participants. In addition, there was no significant time difference (p = 0.4, effect size = 0.2) in answering the questions on MF by using a self-reported digital questionnaire compared to being interviewed by a healthcare professional, based on 18 and 14 participants, in each group. There was significant difference in the time spent for placement of the blood pressure (BP) cuffs when done by a healthcare professional compared to the participants doing it themselves, (p < 0.001, effect size = 0.8), based on 32 participants, where participants would be slower than the healthcare professional. In conclusion, we found that if a screening programme for PE is introduced, the duration for the first trimester ultrasound scan should be extended by 5 min to include the UtA-PI measurement. Also, guidance is needed to assist the woman or her partner to choose and place the BP cuffs correctly, otherwise it could require extra staff resources. Finally, the participants are likely to be able to self-report MF using a tablet user interface.