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Predicting delivery of a small-for-gestational-age infant and adverse perinatal outcome in women with suspected pre-eclampsia

Research output: Contribution to journalArticle

M. Griffin, Paul T. Seed, S. Duckworth, R. North, Jenny Myers, L. Mackillop, N. Simpson, J. Waugh, Maternal Medicine, D. Anumba, L. C. Kenny, C.W.G. Redman, A. H. Shennan, L. C. Chappell

Original languageEnglish
Pages (from-to)387–395
JournalUltrasound in Obstetrics and Gynecology
Volume51
Issue number3
Early online date7 Feb 2018
DOIs
Publication statusPublished - Mar 2018

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Abstract

Objective: To evaluate the test performance of 47 biomarkers and ultrasound parameters for the prediction of delivery of a small-for-gestational-age (SGA) infant and adverse perinatal outcome in women presenting with suspected pre-eclampsia. Methods: This was a prospective, multicenter observational study in which 47 biomarkers and ultrasound parameters were measured in 397 women with a singleton pregnancy presenting with suspected preterm pre-eclampsia between 20+0 and 36+6 weeks' gestation, with the objective of evaluating them as predictors of subsequent delivery of a SGA infant and adverse perinatal outcome. Women with confirmed pre-eclampsia at enrollment were excluded. Factor analysis and stepwise logistic regression were performed in two prespecified groups stratified according to gestational age at enrollment. The primary outcome was delivery of a SGA infant with a birth weight <3rd customized centile (SGA-3), and secondary outcomes were a SGA infant with a birth weight <10th customized centile and adverse perinatal outcome. Results: In 274 women presenting at 20+0 to 34+6 weeks' gestation, 96 (35%) delivered a SGA-3 infant. For prediction of SGA-3, low maternal placental growth factor (PlGF) concentration had a sensitivity of 93% (95% CI, 84-98%) and negative predictive value (NPV) of 90% (95% CI, 76-97%) compared with a sensitivity of 71% (95% CI, 58-82%) and a NPV of 79% (95% CI, 68-87%) for ultrasound parameters (estimated fetal weight or abdominal circumference <10th centile). No individual biomarker evaluated had a better performance than did PlGF, and marker combinations made only small improvements to the test performance. Similar results were found in 123 women presenting between 35+0 and 36+6 weeks' gestation. Conclusion: In women presenting with suspected preterm pre-eclampsia, measurement of PlGF offers a useful adjunct for identifying those at high risk of delivering a SGA infant, allowing appropriate surveillance and timely intervention.

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