Comparison of screening for pre-eclampsia at 31-34 weeks' gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF
Tan, M.Y., Wright, D., Koutoulas, L., Akolekar, R. and Nicolaides, K.H. 2017. Comparison of screening for pre-eclampsia at 31-34 weeks' gestation by sFlt-1/PlGF ratio and a method combining maternal factors with sFlt-1 and PlGF. Ultrasound in Obstetrics and Gynecology. 49 (2), pp. 201-208.
|Authors||Tan, M.Y., Wright, D., Koutoulas, L., Akolekar, R. and Nicolaides, K.H.|
Objective: To estimate the patient-specific risk of preeclampsia (PE) at 31-34 weeks’ gestation by a combination of maternal characteristics and medical history with multiple of the median (MoM) values of serum placental growth factor (PLGF) and serum soluble fms-like tyrosine kinase-1 (sFLT-1) and compare the performance of screening to that achieved by the sFLT-1 to PLGF ratio.
Methods: This was a prospective observational study in women attending for a third-trimester ultrasound scan at 31-34 weeks as part of routine pregnancy care. We estimated the performance of screening of PE with delivery within four weeks of assessment (PE at <4 weeks) and PE from four weeks after assessment and up to 40 weeks’ gestation (PE at 4w-40GW) in screening by the sFLT-1 to PLGF ratio and by a to PLGF ratio and by a method utilizing Bayes theorem to combine maternal factors and MoM values of sFLT-1 and PLGF. The significance of difference in performance of screening between the method utilising Bayes theorem and that of the sFLT-1 to PLGF ratio was assessed by comparison of the areas under the receiver operating characteristic curves (AUROC).
Results: The study population of 8,063 singleton pregnancies included 231 (2.9%) that subsequently developed PE. In the prediction of delivery with PE at <4 weeks the performance of the method utilising Bayes theorem was similar to that of the sFLT-1 to PLGF (AUROC: 0.987, 95%CI 0.979-0.995 vs. 0.988, 95%CI: 0.981-0.994; p=0.961). and at fixed fixed screen positive rate (SPR) of 3.9% the detection rate (DR) was 87.1% for both methods. In contrast, the performance of screening for delivery with PE at 4w-40GW was better with the method utilising Bayes theorem than with the sFLT-1 to PLGF ratio
Conclusion: At 31-34 weeks’ gestation the performance of screening for PE at <4 weeks from assessment by the method utilising Bayes theorem is similar to that of the sFLT-1 to
|Keywords||Placental growth factor; Soluble fms-like tyrosine kinase-1; Preeclampsia; Pyramid of antenatal care|
|Journal||Ultrasound in Obstetrics and Gynecology|
|Journal citation||49 (2), pp. 201-208|
|Publisher||John Wiley & Sons Ltd|
|Digital Object Identifier (DOI)||doi:10.1002/uog.17307|
|Online||27 Sep 2016|
|Publication process dates|
|Accepted||15 Sep 2016|
|Deposited||10 Jun 2020|
|Accepted author manuscript|
1. Maynard SE, Min JY, Merchan J, Maynard SE, Min JY, Merchan J, Lim KH,
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