Clinical/Pathophysiological Implications?
Prematurity, preterm preeclampsia, Preeclampsia, preeclampsia
DISORDER, PRETERM BIRTH, PREMATURITY, PREECLAMPSIA, COMPLICATIONS, PREECLAMPSIA, PERINATAL MORBIDITY
It is important to consider different sFlt-1/PlGF ratio and fullPIERS thresholds for maternal and perinatal outcomes, mainly preterm deliveries. Additionally, developing a continuous knowledge transfer program to help care providers to gain confidence with new tests is crucial for implementation.
Preeclampsia is a complex disorder with diverse phenotypes that affects ≈5% of pregnant women worldwide and is a major cause of maternal and perinatal morbidity and mortality.Despite known perinatal disadvantages, mainly at gestational ages before 34 weeks of pregnancy, the incidence of preterm birth among patients with preterm preeclampsia is still high. In Brazil, preeclampsia is the indication for almost 18% of all preterm births and nearly half of all iatrogenic preterm deliveries.Current nonstandardized methods of risk stratification use clinical and biochemical criteria, but more recently, improved approaches have been described. Identification of which patients can be safely managed expectantly to minimize the effect of iatrogenic deliveries on perinatal outcomes may be beneficial. The preeclampsia integrated estimate of risk (fullPIERS) algorithm uses maternal symptoms, signs, and laboratory tests to identify patients at increased risk for maternal complications related to preeclampsia, predicting adverse maternal outcomes within 48 hours (area under receiver operating curve, 0.88), with a negative predictive value of 98%.The objective of the PREPARE (Prematurity Reduction by Preeclampsia Care) study was to test the hypothesis that risk stratification of patients with suspected or confirmed preeclampsia based on objective criteria reduced the proportion of medically indicated preterm deliveries. The intervention combined fullPIERS and sFlt-1/PlGF ratio in the same treatment guidance to advise obstetricians to defer delivery. Patients with fullPIERS <10% and sFlt-1/PlGF ratio ≤38 were considered as low risk for adverse outcomes and suitable for safe expectant management, while those identified as being at higher risk could be offered appropriate surveillance. Based on this premise, we hypothesized that using this approach we would reduce preterm deliveries related to preeclampsia.