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- Title
The predictive value of the sFlt‐1/PlGF ratio in suspected preeclampsia in a New Zealand population: A prospective cohort study.
- Authors
Hughes, Ruth C.E.; Phillips, Ian; Florkowski, Chris M.; Gullam, Joanna
- 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.
- Subjects
NEW Zealand; 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
- Publication
Australian & New Zealand Journal of Obstetrics & Gynaecology, 2023, Vol 63, Issue 1, p34
- ISSN
0004-8666
- Publication type
Article
- DOI
10.1111/ajo.13549