Perspectives
eclampsia, preeclampsia
PRETERM BIRTH, HYPERTENSION, ECLAMPSIA, PREECLAMPSIA
To our knowledge, this is the first study to combine clinical and laboratory information from the fullPIERS algorithm with the sFlt-1/PlGF ratio in the care of patients with suspected or confirmed preeclampsia. The main findings of our trial showed that the introduction of a new methodology for evaluating patients with hypertension, characterized by a biomarker test incorporating angiogenic and antiangiogenic factors, did not lead to a reduction in preterm birth.Interestingly, there was a large discrepancy between the 2 models combined (fullPIERS and sFlt-1/PlGF). A high majority (97.8%) of patients enrolled into the trial were classified as low risk for adverse maternal outcomes according to the fullPIERS criterion alone. However, 59.6% of these women had sFlt-1/PlGF ratio >38, indicating a nonreassuring result in the initial risk assessment.There was increased knowledge mobilization on preeclampsia by clinicians participating in the study, with an abnormal sFlt-1/PlGF ratio leading to a higher possibility of identifying preeclampsia with severe features, with reduction in cases of eclampsia in the intervention group.Although the potential role of angiogenic imbalance in risk identification, there is no consensus on a specific cutoff to identify patients at higher risk for adverse outcomes or whether a pattern of elevation of the sFlt-1/PlGF ratio could be useful to define timing of delivery to improve either maternal or perinatal outcomes. Equally, there is still no clear consensus on the threshold of the fullPIERS algorithm that best determines need for delivery, particularly at gestational ages <37 weeks.Therefore, our results will encourage future researches to evaluate the impact of using different test thresholds on maternal and perinatal outcomes, focusing on optimizing timing of delivery in low- and middle-income settings.