Integration of Conventional Antenatal Screening, Molecular Biomarkers, and Ultrasonography in the Early Detection of Preeclampsia: A PRISMA-Based Systematic Review
Abstract
ABSTRACT
Background: Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality in maternal healthcare. In Indonesia, conventional antenatal screening based on the Maternal and Child Health (KIA) handbook has been systematically implemented through anamnesis, physical examinations, basic laboratory tests, and
ultrasonography. However, the majority of preeclampsia cases are still diagnosed in the late trimesters once clinical manifestations have already developed, thereby limiting the window for preventive interventions. Objective: This systematic review aims to evaluate the limitations of conventional antenatal screening and to assess the role of molecular biomarkers and Doppler ultrasonography in improving the early detection of preeclampsia. Methods: This study utilized a Systematic Literature Review (SLR) approach based on the PRISMA 2020 guidelines, conducting a systematic search across international databases including PubMed, Scopus, and Web of Science for articles published between 2015 and 2025. The article search and screening process were conducted from January to March 2026. Results: Conventional antenatal screening (risk anamnesis, blood pressure, MAP, proteinuria, hematology, routine urinalysis,
SGOT, SGPT, ureum, and creatinine) has limited sensitivity (30–55%) in identifying preeclampsia risk during early pregnancy, as routine laboratory parameters only manifest once end-organ damage occurs. Various angiogenic molecular biomarkers (sFlt-1, PlGF, and the sFlt-1/PlGF ratio) alongside simple inflammatory markers (NLR and PLR) show consistent alterations starting from the first trimester, well before clinical symptoms appear. The integration of these three components—supported by enhancing the basic ultrasonography competence of general practitioners at primary health care (FKTP) facilities and utilizing triadic Doppler ultrasound examinations (uterine, umbilical, and MCA arteries) at referral facilities—enables a more accurate risk stratification through a tiered referral system. Conclusion: Conventional antenatal screening is suboptimal when utilized in isolation. An integrative approach via a Tiered Risk Stratification System serves as a strategic solution for the early detection of preeclampsia and the reduction of maternal-perinatal complications. Keywords: preeclampsia, antenatal screening, KIA handbook, molecular biomarkers, Doppler ultrasonography, early detection.
Full text article
Authors
Copyright (c) 2026 Deden Kurniawan
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlikel 4.0 International (CC BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).