1. The predictive value of the sFlt‐1/PlGF ratio in suspected preeclampsia in a New Zealand population: A prospective cohort study.
- Author
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Hughes, Ruth C.E., Phillips, Ian, Florkowski, Chris M., and Gullam, Joanna
- Subjects
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RISK factors of preeclampsia , *PLACENTAL growth factor , *CHILDBIRTH , *MAGNESIUM sulfate , *LENGTH of stay in hospitals , *STATISTICS , *PREDICTIVE tests , *PREMATURE infants , *INTRAVENOUS therapy , *NEONATAL intensive care , *STROKE , *CONFIDENCE intervals , *ABRUPTIO placentae , *CELL receptors , *GESTATIONAL age , *NEONATAL intensive care units , *PATIENTS , *FETAL growth retardation , *FISHER exact test , *MANN Whitney U Test , *RISK assessment , *PREGNANCY outcomes , *HOSPITAL admission & discharge , *COMPARATIVE studies , *T-test (Statistics) , *PULMONARY edema , *DESCRIPTIVE statistics , *CHI-squared test , *KAPLAN-Meier estimator , *CESAREAN section , *MATERNAL mortality , *INFANT mortality , *DATA analysis , *SMOKING , *RECEIVER operating characteristic curves , *SENSITIVITY & specificity (Statistics) , *BLOOD testing , *LONGITUDINAL method , *SMALL for gestational age , *BLOOD , *EVALUATION , *PREGNANCY - Abstract
Background: Internationally, placental growth factor (PlGF)‐based tests are used as prognostic markers in suspected preeclampsia. However, Ministry of Health guidelines do not currently endorse PlGF‐based tests in New Zealand (NZ). Aims: To investigate the predictive value of soluble fms‐like tyrosine kinase 1 (sFlt‐1)/PlGF ratio in suspected preeclampsia in a NZ population. Materials and Methods: A prospective cohort study of singleton pregnancies at 20+0–36+6 weeks gestation with suspected preeclampsia as defined by Society of Obstetric Medicine Australia and NZ (SOMANZ) criteria. Primary objective: to evaluate a sFlt‐1/PlGF ratio >38 at ≤35+0 weeks gestation to predict birth ≤14 days. Secondary objectives: to assess a sFlt‐1/PlGF ratio cut‐off of 38 at ≤37+0 weeks gestation, to rule out preeclampsia ≤1 week, rule in preeclampsia ≤4 weeks, and to predict perinatal outcome. Clinicians were blinded to sFlt‐1/PlGF ratio results. Results: Included were 222 participants, 19.4% Māori and 10.4% Pasifika. A sFlt‐1/PlGF >38 predicted birth ≤14 days, positive predictive value (PPV) 51.4% (95% CI, 39.6–63.0) and negative predictive value (NPV) 95.9% (95% CI, 91.4–98.1), median (interquartile range) days to birth 14 (2–27) vs 49 (33–70), P < 0.000. A sFlt‐1/PlGF cut‐off of 38 ruled out preeclampsia ≤1 week (NPV 96.2% (95% CI, 92.3–98.2)) and ruled in preeclampsia ≤4 weeks (PPV 75.0% (95% CI, 65.0–82.9)). A sFlt‐1/PlGF >38 was associated with greater perinatal morbidity. Conclusions: The predictive value of the sFlt‐1/PlGF ratio in NZ is comparable to that reported in international trials. Used in clinical practice the sFlt‐1/PlGF ratio may aid risk stratification in suspected preeclampsia, directing limited resources to those pregnancies at highest risk. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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