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.

ObjectiveTo evaluate the test performance of 47 biomarkers and ultrasound parameters for the prediction of delivery of a small‐for‐gestational‐age (SGA) infant and adverse perinatal outcome in women presenting with suspected pre‐eclampsia.MethodsThis was a prospective, multicenter observational study in which 47 biomarkers and ultrasound parameters were measured in 397 women with a singleton pregnancy presenting with suspected preterm pre‐eclampsia between 20 + 0 and 36 + 6 weeks' gestation, with the objective of evaluating them as predictors of subsequent delivery of a SGA infant and adverse perinatal outcome. Women with confirmed pre‐eclampsia at enrollment were excluded. Factor analysis and stepwise logistic regression were performed in two prespecified groups stratified according to gestational age at enrollment. The primary outcome was delivery of a SGA infant with a birth weight < 3rd customized centile (SGA‐3), and secondary outcomes were a SGA infant with a birth weight < 10th customized centile and adverse perinatal outcome.ResultsIn 274 women presenting at 20 + 0 to 34 + 6 weeks' gestation, 96 (35%) delivered a SGA‐3 infant. For prediction of SGA‐3, low maternal placental growth factor (PlGF) concentration had a sensitivity of 93% (95% CI, 84–98%) and negative predictive value (NPV) of 90% (95% CI, 76–97%) compared with a sensitivity of 71% (95% CI, 58–82%) and a NPV of 79% (95% CI, 68–87%) for ultrasound parameters (estimated fetal weight or abdominal circumference < 10th centile). No individual biomarker evaluated had a better performance than did PlGF, and marker combinations made only small improvements to the test performance. Similar results were found in 123 women presenting between 35 + 0 and 36 + 6 weeks' gestation.ConclusionIn women presenting with suspected preterm pre‐eclampsia, measurement of PlGF offers a useful adjunct for identifying those at high risk of delivering a SGA infant, allowing appropriate surveillance and timely intervention. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

ObjectiveTo model the resource implications of placental growth factor (PlGF) testing in women with suspected pre-eclampsia prior to 35 weeks’ gestation as part of a management algorithm, compared with current practice.MethodsData on resource use from 132 women with suspected pre-eclampsia prior to 35 weeks’ gestation, enrolled in a prospective observational cohort study evaluating PlGF measurement within antenatal assessment units within two UK consultant-led maternity units was extracted by case note review. A decision analytic model was developed using these data to establish the budget impact of managing women with suspected pre-eclampsia for two weeks from the date of PlGF testing, using a clinical management algorithm and reference cost tariffs. The main outcome measures of resource use (numbers of outpatient appointments, ultrasound investigations and hospital admissions) were correlated to final diagnosis and used to calculate comparative management regimes.ResultsThe mean cost saving associated with the PlGF test (in the PlGF plus management arm) was £35,087 (95% CI -£33,181 to -£36,992) per 1,000 women. This equated to a saving of £582 (95% CI -552 to -£613) per woman tested. In 94% of iterations, PlGF testing was associated with cost saving compared to current practice.ConclusionsThis analysis suggests PlGF used as part of a clinical management algorithm in women presenting with suspected pre-eclampsia prior to 35 weeks’ gestation could provide cost savings by reducing unnecessary resource use. Introduction of PlGF testing could be used to direct appropriate resource allocation and overall would be cost saving.

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Introduction Antenatal corticosteroids to accelerate fetal lung maturation should be administered to women 24 to 34 weeks gestation with any symptoms of imminent delivery,1 with proven benefit up to 2 weeks and possibly 4 weeks after administration. There is concern as to potential harm caused by premature administration or repeated doses.23 Could fetal fibronectin (fFN) testing and ultrasound cervical length (CL) measurement, excellent predictors of preterm birth (PTB), be used to direct steroid administration in high-risk, asymptomatic women? Method Prospective analysis of 284 high-risk asymptomatic women between 22+0 and 32+6 weeks gestation, seen in preterm clinic. Results <1%(CI 0.1 to 3%) of fFN negative women delivered ≤4 weeks of testing, despite CL<25 mm in 43 of these women. 5% (CI 0.1 to 26%), 25%(CI 5 to 57%) and 38% (CI 17 to 64%) of women with positive fFN and CL≤25 mm, 15 to 25 mm and ≤15 mm respectively delivered ≤4 weeks of testing. 33% (CI 13 to 59%) of those with positive fFN and CL≤15 mm delivered prematurely, but >4 weeks from testing, as did 58%(CI 31 to 80%) and 21%(CI 6 to 45%) of fFN positive with CL 15 to 25 mm and ≤25 mm. Conclusions fFN has the potential to prevent the inappropriate use of steroids in screen-negative high-risk women, despite CL. CL adds additional value in screen-positive women. Although 38% of fFN positive and CL<15 mm women delivered within 4 weeks (27% ≤2 weeks), that 33% of these had PTB outside of this steroid window implies that repeat doses may have been necessary. fFN and CL can inform steroid administration, but repeat testing will be required, and further research must establish the risk/benefit of these management strategies.