Can we predict imminent preeclampsia?

  • Ciobanu A & al.
  • Am J Obstet Gynecol
  • 7 Feb 2019

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • For imminent preeclampsia, the combination of mean arterial pressure (MAP), placental growth factor (PLGF), and soluble fms-like tyrosine linase-1s (sFLT) may represent a third-trimester test.

Why this matters

  • Screening tests for imminent preeclampsia would help in management and timing of delivery and reducing maternal complications.

Key results

  • 2.1% developed preeclampsia.
  • The combination of history, MAP, PLGF, and sFLT (triple test) was superior to PLGF alone or the sFLT/PLGF ratio. 
  • The positive predictive values (PPVs) were:
    • 17.9 (cutoff 10; 95% CI, 13.3-23.2) in predicting delivery ≤2 weeks, and
    • 32.9 (cutoff 10, 95% CI, 27.2-39.1) in predicting delivery ≤4 weeks.
  • The negative predictive value (NPV) was similar for the 3 tests.

Study design

  • Prospective observational study.
  • Women undergoing routine visit at 35 weeks 0 days to 36 weeks 6 days enrolled (n=15,247).
  • Serum PLGF and sFLT measured.
  • Detection rate, PPV, and NPV calculated using various combinations of medical history, physical findings, and serum markers.
  • Outcome measures included delivery with preeclampsia ≤2 and ≤4 weeks after assessment.
  • Funding: The Fetal Medicine Foundation.

Limitations

  • Heterogeneous group.
  • These serum marker tests are not available for routine use.
  • Model needs validation.

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