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Screening for pre‐eclampsia using sFlt‐1/PlGF ratio cut‐off of 38 at 30–37 weeks' gestation
Author(s) -
Dragan I.,
Georgiou T.,
Prodan N.,
Akolekar R.,
Nicolaides K. H.
Publication year - 2017
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.17301
Subject(s) - medicine , gestation , placental growth factor , soluble fms like tyrosine kinase 1 , obstetrics , eclampsia , predictive value , prospective cohort study , singleton , preeclampsia , pregnancy , population , gynecology , genetics , vascular endothelial growth factor , vegf receptors , biology , environmental health
Objective To evaluate a soluble fms‐like tyrosine kinase‐1 (sFlt‐1) to placental growth factor (PlGF) ratio cut‐off of 38 for the prediction of pre‐eclampsia (PE) in routine assessment in singleton pregnancies at 30–37 weeks' gestation. Methods This was a prospective observational study in women attending a third‐trimester ultrasound scan at 30–37 weeks as part of routine pregnancy care. Serum sFlt‐1 and PlGF were measured and their ratio was calculated. We estimated the detection rate (DR), false‐positive rate (FPR), positive predictive value (PPV) and negative predictive value (NPV) of sFlt‐1/PlGF ratio >38 for the prediction of delivery with PE at < 1, < 4 and ≥ 4 weeks after assessment. Results The study population of 12 305 singleton pregnancies was examined at a median of 32.4 (range, 30.0–36.9) weeks and included 14 (0.11%), 77 (0.63%) and 227 (1.84%) cases that subsequently delivered with PE at < 1, < 4 or ≥ 4 weeks' after assessment, respectively. The DR, FPR, PPV and NPV of sFlt‐1/PlGF ratio > 38 in the prediction of delivery with PE at < 1 week were 78.6%, 4.5%, 1.9% and 99.97%, respectively; the values for delivery with PE at < 4 weeks were 76.6%, 4.1%, 10.4% and 99.85% and for delivery with PE ≥ 4 weeks were 20.7%, 4.3%, 8.3% and 98.47%. Conclusion In routine screening of singleton pregnancies, the performance of a sFlt‐1/PlGF ratio > 38 is modest for the prediction of delivery with PE at < 1 and at < 4 weeks after assessment and poor for the prediction of delivery with PE at ≥ 4 weeks after assessment. A sFlt‐1/PlGF ratio > 38 predicted 79% of cases delivering with PE at < 1 week after assessment, at a FPR of 4.5%; consequently, a policy of hospitalizing patients with a ratio > 38 would potentially lead to unnecessary hospitalization in 4.5% of pregnancies and a ratio of ≤ 38 would falsely reassure one fifth of women who will deliver with PE within 1 week of assessment. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.