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Prediction of imminent preeclampsia at 35–37 weeks gestation

Research output: Contribution to journalArticle

Anca Ciobanu, Alan Wright, Anca Panaitescu, Argyro Syngelaki, David Wright, Kypros H. Nicolaides

Original languageEnglish
Pages (from-to)584.e1-584.e11
JournalAmerican Journal of Obstetrics and Gynecology
Volume220
Issue number6
Early online date7 Feb 2019
DOIs
Publication statusPublished - 1 Jun 2019

King's Authors

Abstract

BACKGROUND In the weeks preceding the clinical onset of preeclampsia (PE) the maternal serum level of the angiogenic placental growth factor (PLGF) is decreased and that of the antiangiogenic factor soluble fms-like tyrosine kinase-1 (sFLT) is increased. Women presenting at specialist clinics with signs or symptoms of hypertensive disorders have been stratified according to concentrations of PLGF or the ratio of concentrations of sFLT and PLGF to determine clinical management for the subsequent 1-4 weeks. An alternative approach for the prediction of PE is use of the competing risks model, a Bayes' theorem based method, to derive patient-specific risk for PE by various combinations of maternal characteristics and medical history with multiples of the median (MoM) values of biomarkers. OBJECTIVE To compare the performance of screening for delivery with PE at ≤2 and ≤4 weeks after assessment at 35+0 - 36+6 weeks' gestation between the use of percentile cut-offs in PlGF alone or the sFLT / PlGF ratio and the competing risks model. METHODS This was a prospective observational study in women attending for a routine hospital visit at 35+0 - 36+6 weeks' gestation in two maternity hospitals in England. The visits included recording of maternal demographic characteristics and medical history, and measurement of serum PlGF and sFLT and mean arterial pressure (MAP). The areas under the receiver operating characteristics curves (AUROC) were used to compare the predictive performance for PE with delivery at ≤2 and ≤4 weeks from assessment of screening by PlGF alone and the sFLT / PlGF ratio to that of a previously developed competing risks model with a combination of maternal factors, PlGF, sFLT and MAP (triple test). RESULTS First, the study population of 15,247 pregnancies included 326 (2.1%) that subsequently developed PE. Second, in screening for delivery with PE at ≤2 and ≤4 weeks from assessment the performance of the triple test was superior to that of PlGF alone or the sFLT / PlGF ratio. The AUROC for PE at ≤2 weeks in screening by the triple test (0.975, 95% CI 0.964, 0.985) was higher than that of PlGF alone (0.900, 95% CI 0.866, 0.935; p

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