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OP 2 Placental growth factor informed management of suspected pre-eclampsia and/or fetal growth restriction: The MAPPLE cohort study

Research output: Contribution to journalMeeting abstractpeer-review

Andrew Sharp, Lucy Chappell, Gustaaf Dekker, Sanja Pelletier, Yves Garnier, Onur Zeren, Katharina M. Hillerer, Thorsten Fischer, Paul Seed, Mark Turner, Andrew Shennan, Zarko Alfirevic

Original languageEnglish
Pages (from-to)9-10
Number of pages2
JournalPregnancy Hypertension
Volume9
DOIs
E-pub ahead of print12 Aug 2017

King's Authors

Abstract

Objective: To assess the clinical impact of measuring Placental Growth Factor (PlGF) to monitor high-risk pregnancies. 
Design: Prospective cohort study. 
Setting: Four large teaching hospitals in UK, Germany, Austria and Australia. 
Population: Women <35 weeks’ gestation with suspected pre-eclampsia and/or fetal growth restriction in whom PLGF was measured as part of clinical care. 
Methods: Demographic and clinical outcome data were obtained and compared with data from the previously published PELICAN study where PLGF results were not revealed to clinicians. Pre-specified outcomes from the two cohorts were compared using standard statistical tests (mean difference or Risk Ratio). The results were further categorised according to the PLGF concentrations: (i) very low (<12 pg/ml), (ii) low (12–100 pg/ml), (iii) normal (>100 pg/ml). 
Main outcome measures: Maternal adverse outcomes (death, CNS, respiratory, haematological, hepatic, renal, placental abruption); perinatal adverse outcomes (stillbirth, early neonatal death, neonatal complications, NICU admissions). 
Results: 397 women managed with revealed PlGF (MAPPLE) were compared with 287 women with concealed PLGF (PELICAN). Women with revealed PlGF were delivered 1.4 weeks earlier (−2.0 to −0.9). There were no significant differences in proportion with maternal adverse outcomes (10.1% vs 10.5%, Risk Ratio (RR) 0.96, 95%CI 0.62–1.51) or the Caesarean section rate (66.1% vs 56.5%; RR 1.16, 95%CI 1.04–1.31). There were fewer perinatal deaths with revealed PLGF (2 vs 9; RR 0.16, 95%CI 0.03–0.74) and fewer babies with birth weight <10th centile (31.2% vs 47.5%; RR 0.66, 95% CI 0.55–0.79). However, there were more perinatal adverse outcomes with revealed PLGF (30.7% vs 20.4%; RR 1.51, 95%CI 1.16–1.96), mainly due to more respiratory morbidity. 
Conclusions: Revealed PlGF results may be associated with lower perinatal mortality and fewer small for gestational age babies but appear to lead to earlier delivery with more neonatal respiratory morbidity. Ongoing and future randomised trials should have adequate power to confirm or refute our findings.

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