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The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo
Published on: August 2, 2017
Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study
Lucy C Chappell1, Suzy Duckworth, Paul T Seed
1Women's Health Academic Centre, King's College London, London, UK (L.C.C., S.D., P.T.S., M.G., A.H.S.); Maternal and Fetal Health Research Centre, University of Manchester, UK (J.M.); Oxford University Hospitals NHS Trust, Oxford, UK (L.M.); Section of Obstetrics & Gynaecology, University of Leeds, UK (N.S.); Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK (J.W.); Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, UK (D.A.); The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Ireland (L.C.K.); and Nuffield Department of Obstetrics and Gynaecology, University of Oxford, UK (C.W.G.R.).
Background:
Hypertensive disorders of pregnancy are a major contributor to death and disability for pregnant women and their infants. The diagnosis of preeclampsia by using blood pressure and proteinuria is of limited use because they are tertiary, downstream features of the disease. Placental growth factor (PlGF) is an angiogenic factor, a secondary marker of associated placental dysfunction in preeclampsia, with known low plasma concentrations in the disease.
Methods And Results:
In a prospective multicenter study, we studied the diagnostic accuracy of low plasma PlGF concentration (<5th centile for gestation, Alere Triage assay) in women presenting with suspected preeclampsia between 20 and 35 weeks' gestation (and up to 41 weeks' gestation as a secondary analysis). The outcome was delivery for confirmed preeclampsia within 14 days. Of 625 women, 346 (55%) developed confirmed preeclampsia. In 287 women enrolled before 35 weeks' gestation, PlGF <5th centile had high sensitivity (0.96; 95% confidence interval, 0.89-0.99) and negative predictive value (0.98; 0.93-0.995) for preeclampsia within 14 days; specificity was lower (0.55; 0.48-0.61). Area under the receiver operating characteristic curve for low PlGF (0.87, standard error 0.03) for predicting preeclampsia within 14 days was greater than all other commonly used tests, singly or in combination (range, 0.58-0.76), in women presenting with suspected preeclampsia (P<0.001 for all comparisons).
Conclusions:
In women presenting before 35 weeks' gestation with suspected preeclampsia, low PlGF has high sensitivity and negative predictive value for preeclampsia within 14 days, is better than other currently used tests, and presents an innovative adjunct to management of such women.
