Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
Department of Women and Children's Health, University of Liverpool, Liverpool, UK.
Acta Obstet Gynecol Scand. 2020 Aug;99(8):994-1002. doi: 10.1111/aogs.13818. Epub 2020 Feb 29.
Preeclampsia affects about 3% of singleton pregnancies and is characterized by placental dysfunction. It is associated with significant maternal and perinatal morbidity and mortality. The diagnosis of preeclampsia remains a challenge, and the clinical course can develop for weeks before a diagnosis is confirmed. National guidelines have approved placental growth factor (PlGF) testing to rule out suspected preeclampsia, but the utility of repeated PlGF measurement is unknown. The aim of this case series analysis was to evaluate the test performance of repeated PlGF sampling in women presenting with suspected preeclampsia, and to describe relevant clinical outcomes.
Women who presented to maternity services with suspected preeclampsia between 20 and 36 weeks' gestation who underwent repeat PlGF sampling with a minimum test interval of 7 days were assessed. The outcomes were delivery for preeclampsia within 14 days of sampling, the proportion changing PlGF categories, and time to delivery.
In total, 289 women with suspected preeclampsia undergoing repeat PlGF sampling were included. PlGF <100 pg/mL had a high sensitivity (87.5%, 95% confidence interval [CI] 67.6%-97.3%) and a negative predictive value (97.7%, 95% CI 93.5%-99.5%) at the initial test (receiver operating characteristic [ROC] area 0.79, 95% CI 0.68-0.89). Similar test performance was seen for PlGF <100 pg/mL when undertaken as a repeat test (sensitivity 90.7%, 95% CI 85.2%-95.9%, negative predictive value 92.2%, 95% CI 85.3-96.6%). Overall, 25.6% of women changed PlGF category between the first and second PlGF tests. For each PlGF category, determination of time to delivery was similar for first and second tests.
Repeat PlGF measurement demonstrates high negative predictive value for determining preeclampsia requiring delivery in 14 days. Repeat testing may be clinically useful to risk stratify women with ongoing symptoms of disease. Confirmation of the impact of these findings is required in further studies.
子痫前期影响约 3%的单胎妊娠，其特征是胎盘功能障碍。它与显著的母亲和围产期发病率和死亡率有关。子痫前期的诊断仍然是一个挑战，在确诊前，临床病程可能会发展数周。国家指南已经批准了胎盘生长因子（PlGF）检测以排除疑似子痫前期，但重复 PlGF 测量的效用尚不清楚。本病例系列分析的目的是评估在疑似子痫前期患者中重复 PlGF 采样的检测性能，并描述相关的临床结局。
在 20 至 36 周妊娠期间因疑似子痫前期就诊于产科服务的患者接受了重复 PlGF 采样，两次采样的最小间隔时间为 7 天。评估的结局包括采样后 14 天内因子痫前期分娩、PlGF 类别改变的比例以及分娩时间。
共有 289 名疑似子痫前期患者接受了重复 PlGF 采样，结果如下。初次检测时 PlGF<100pg/mL 具有高灵敏度（87.5%，95%置信区间[CI]67.6%-97.3%）和高阴性预测值（97.7%，95%CI 93.5%-99.5%）（接受者操作特征[ROC]曲线下面积 0.79，95%CI 0.68-0.89）。当作为重复测试时，PlGF<100pg/mL 也表现出相似的测试性能（灵敏度 90.7%，95%CI 85.2%-95.9%，阴性预测值 92.2%，95%CI 85.3-96.6%）。总体而言，25.6%的女性在第一次和第二次 PlGF 检测之间改变了 PlGF 类别。对于每个 PlGF 类别，第一次和第二次检测确定分娩时间的结果相似。
重复 PlGF 测量对于确定 14 天内需要分娩的子痫前期具有高阴性预测值。重复检测可能对有疾病持续症状的女性进行风险分层具有临床意义。需要进一步的研究来证实这些发现的影响。
