Clinical implementation of the sFlt-1/PlGF ratio to identify preeclampsia and fetal growth restriction: A prospective cohort study.
Pregnancy Hypertens
; 13: 279-285, 2018 Jul.
Article
em En
| MEDLINE
| ID: mdl-30177066
ABSTRACT
OBJECTIVE:
To analyze the usefulness of a clinical protocol for early detection of preeclampsia and/or fetal growth restriction (PE/FGR) using, in previously selected pregnancies, the measurement of the sFlt-1/PlGF ratio at 24-28â¯weeks of gestation. STUDYDESIGN:
Prospective observational cohort study carried out in a single tertiary hospital in Spain. 5601 consecutive singleton pregnancies with complete follow-up were included. High-risk women for PE/FGR were selected by combining data from maternal history and second trimester uterine artery Doppler. Subsequently these patients underwent intensive monitoring, including the measurement of the sFlt-1/PlGF ratio at 24-28â¯weeks to predict PE/FGR. MAIN OUTCOMEMEASURES:
Early, intermediate and late PE/FGR (delivery <32â¯+â¯0, 32â¯+â¯0 - <36â¯+â¯0 and ≥36â¯+â¯0â¯weeks, respectively).RESULTS:
Overall incidence of early, intermediate and late PE/FGR was 0.3%, 0.7% and 3.2%, respectively, being higher in the 4.3% of women selected for intensive monitoring 5.8%, 8.7% and 15.4%, respectively (all pâ¯<â¯0.001). The area under the curve (AUC) with 95%CI of the sFlt-1/PlGF ratio for detecting early PE/FGR was 0.98 (0.97-1.00), and the sFlt-1/PlGF ratio >95th centile showed a sensitivity (%) of 100 (95%CI, 78.5-100) and specificity (%) of 80.6 (95%CI, 75.0-85.2). The AUC of the sFlt-1/PlGF ratio for detecting intermediate and late PE/FGR was of 0.87 (95%CI, 0.77-0.97) and 0.68 (95%CI, 0.58-0.79), respectively.CONCLUSION:
A contingent strategy of measuring the sFlt-1/PlGF ratio at 24-28â¯weeks in women previously selected by clinical factors and uterine artery Doppler enables an accurate prediction of PE/FGR. This performance is optimal to predict PE/FGR requiring delivery before 32â¯weeks.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pré-Eclâmpsia
/
Receptor 1 de Fatores de Crescimento do Endotélio Vascular
/
Retardo do Crescimento Fetal
/
Fator de Crescimento Placentário
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limite:
Adult
/
Female
/
Humans
/
Pregnancy
País/Região como assunto:
Europa
Idioma:
En
Revista:
Pregnancy Hypertens
Ano de publicação:
2018
Tipo de documento:
Article