Researching New Methods of Screening for Adverse Pregnancy Outcome: Lessons from Pre-eclampsia

Complications of pregnancy contribute to a substantial proportion of the global burden of disease [1]. Most adverse pregnancy outcomes occur to women who lack obvious risk factors. However, despite many years of research, the current approach to screening low-risk women for complications such as pre-eclampsia and stillbirth is still based around serial measurement of blood pressure, urinalysis, and symphysis-fundal height [2]. In this Essay, I argue that the failure to develop more effective programmes of screening and intervention is due in part to limitations in the approach to research in this area. The arguments will be illustrated using utero-placental Doppler flow velocimetry and screening for pre-eclampsia as an example. Many of the principles are relevant for trials of other methods of screening and intervention to prevent preeclampsia, for other adverse pregnancy outcomes (stillbirth in particular), and in other areas of medicine.