scholarly journals The Prognostic Value of Angiogenic Markers in Twin Pregnancies to Predict Delivery Due to Maternal Complications of Preeclampsia

Hypertension ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 176-183 ◽  
Author(s):  
Julia Binder ◽  
Pilar Palmrich ◽  
Petra Pateisky ◽  
Erkan Kalafat ◽  
Lorenz Kuessel ◽  
...  
Keyword(s):  
Predictive Value ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Blood Sampling ◽  
Maternal Complications ◽  
Retrospective Data Analysis ◽  
Twin Pregnancies ◽  
Plgf Ratio ◽  
Rule Out ◽  
Singleton Pregnancies

The sFlt-1 (soluble fms-like tyrosine kinase-1), PlGF (placental growth factor), and their ratio are useful for predicting delivery because of preeclampsia in singleton pregnancies. Evidence on the utility of sFlt-1/PlGF ratio in twin pregnancies is lacking. We aimed to evaluate the predictive value of sFlt-1/PlGF ratio for delivery because of preeclampsia in twins. A retrospective data analysis of 164 twin pregnancies with suspected preeclampsia was performed. The sFlt-1/PlGF ratio, which was known to clinicians, was significantly higher in women who delivered within 1 and 2 weeks compared with those who did not (median: 98.9 and 84.2 versus 23.5 pg/mL, respectively; P <0.001). The area under the curve values sFlt-1/PlGF ratio levels were 0.88 (95% CI, 0.83–0.84) and 0.88 (95% CI, 0.83–0.93) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling, respectively. The predictive accuracy of sFlt-1/PlGF was independent of gestational age at sampling and chorionicity ( P >0.100 for interaction). The area under the curve values of sFlt-1/PlGF were significantly higher than for PlGF alone (mean 0.88 and 0.88 versus 0.81 and 0.80) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling ( P =0.055 and 0.001, respectively). sFlt-1/PlGF ratio lower than 38 was able to rule-out delivery within 1 and 2 weeks with a negative predictive value of 98.8% and 96.4% for delivery because of preeclampsia within 1 and 2 weeks, respectively. A cutoff of 38 is applicable for ruling out delivery because of preeclampsia in twin pregnancies.

A more accurate prediction to rule in and rule out pre-eclampsia using the sFlt-1/PlGF ratio and NT-proBNP as biomarkers

2020 ◽  
Vol 58 (3) ◽  
pp. 399-407
Author(s):  
Paula Lafuente-Ganuza ◽  
Paloma Lequerica-Fernandez ◽  
Francisco Carretero ◽  
Ana I. Escudero ◽  
Eduardo Martinez-Morillo ◽  
...  
Keyword(s):  
Predictive Value ◽  
Early Onset ◽  
Retrospective Cohort ◽  
Validation Cohort ◽  
Placental Growth Factor ◽  
Machine Learning Model ◽  
Positive Results ◽  
Plgf Ratio ◽  
Rule Out ◽  
Singleton Pregnancies

AbstractBackgroundThe management of potential pre-eclamptic patients using the soluble FMS-like tyrosine kinase 1 (sFlt-1)/ placental growth factor (PlGF) ratio is characterised by frequent false-positive results.MethodsA retrospective cohort study was conducted to identify and validate cut-off values, obtained using a machine learning model, for the sFlt-1/PlGF ratio and NT-proBNP that would be predictive of the absence or presence of early-onset pre-eclampsia (PE) in singleton pregnancies presenting at 24 to 33 + 6 weeks of gestation.ResultsFor the development cohort, we defined two sFlt-1/PlGF ratio cut-off values of 23 and 45 to rule out and rule in early-onset PE at any time between 24 and 33 + 6 weeks of gestation. Using an sFlt-1/PlGF ratio cut-off value of 23, the negative predictive value (NPV) for the development of early-onset PE was 100% (95% confidence interval [CI]: 99.5–100). The positive predictive value (PPV) of an sFlt-1/PlGF ratio >45 for a diagnosis of early-onset PE was 49.5% (95% CI: 45.8–55.6). When an NT-proBNP value >174 was combined with an sFlt-1/PlGF ratio >45, the PPV was 86% (95% CI: 79.2–92.6). In the validation cohort, the negative and positive values were very similar to those found for the development cohort.ConclusionsAn sFlt-1/PlGF ratio <23 rules out early-onset PE between 24 and 33 + 6 weeks of gestation at any time, with an NPV of 100%. An sFlt-1/PlGF ratio >45 with an NT-proBNP value >174 significantly enhances the probability of developing early-onset PE.

scholarly journals New screening approach to detecting congenital syphilis in China: a retrospective cohort study

2020 ◽  
pp. archdischild-2020-320549
Author(s):  
Fang Hu ◽  
Shuai-Jun Guo ◽  
Jian-Jun Lu ◽  
Ning-Xuan Hua ◽  
Yan-Yan Song ◽  
...  
Keyword(s):  
Predictive Value ◽  
Congenital Syphilis ◽  
Area Under The Curve ◽  
Diagnostic Tools ◽  
Operating Characteristics ◽  
Loss To Follow Up ◽  
Sensitivity Specificity ◽  
Mother To Child ◽  
Rule Out

BackgroundDiagnosis of congenital syphilis (CS) is not straightforward and can be challenging. This study aimed to evaluate the validity of an algorithm using timing of maternal antisyphilis treatment and titres of non-treponemal antibody as predictors of CS.MethodsConfirmed CS cases and those where CS was excluded were obtained from the Guangzhou Prevention of Mother-to-Child Transmission of syphilis programme between 2011 and 2019. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) using receiver operating characteristics (ROC) in two situations: (1) receiving antisyphilis treatment or no-treatment during pregnancy and (2) initiating treatment before 28 gestational weeks (GWs), initiating after 28 GWs or receiving no treatment for syphilis seropositive women.ResultsAmong 1558 syphilis-exposed children, 39 had confirmed CS. Area under the curve, sensitivity and specificity of maternal non-treponemal titres before treatment and treatment during pregnancy were 0.80, 76.9%, 78.7% and 0.79, 69.2%, 88.7%, respectively, for children with CS. For the algorithm, ROC results showed that PPV and NPV for predicting CS were 37.3% and 96.4% (non-treponemal titres cut-off value 1:8 and no antisyphilis treatment), 9.4% and 100% (non-treponemal titres cut-off value 1:16 and treatment after 28 GWs), 4.2% and 99.5% (non-treponemal titres cut-off value 1:32 and treatment before 28 GWs), respectively.ConclusionsAn algorithm using maternal non-treponemal titres and timing of treatment during pregnancy could be an effective strategy to diagnose or rule out CS, especially when the rate of loss to follow-up is high or there are no straightforward diagnostic tools.

The predictive value of the sFlt-1/PlGF ratio on short-term absence of preeclampsia and maternal and fetal or neonatal complications in twin pregnancies

2018 ◽  
Vol 14 ◽  
pp. 222-227 ◽  
Author(s):  
Langeza Saleh ◽  
Sarea I.M. Tahitu ◽  
A.H. Jan Danser ◽  
Anton H. van den Meiracker ◽  
Willy Visser
Keyword(s):  
Predictive Value ◽  
Short Term ◽  
Neonatal Complications ◽  
Twin Pregnancies ◽  
Plgf Ratio

scholarly journals Maternal serum sFlt-1/PlGF ratio in twin pregnancies with and without pre-eclampsia in comparison with singleton pregnancies

2015 ◽  
Vol 45 (3) ◽  
pp. 286-293 ◽  
Author(s):  
L. Dröge ◽  
I. Herraìz ◽  
H. Zeisler ◽  
D. Schlembach ◽  
H. Stepan ◽  
...  
Keyword(s):  
Maternal Serum ◽  
Twin Pregnancies ◽  
Plgf Ratio ◽  
Singleton Pregnancies

scholarly journals Study of maternal and fetal outcome in twin pregnancy

2017 ◽  
Vol 6 (6) ◽  
pp. 2272 ◽  
Author(s):  
Lata Singh ◽  
Kiran Trivedi
Keyword(s):  
Mortality Rate ◽  
Perinatal Mortality ◽  
Twin Pregnancy ◽  
Fetal Outcome ◽  
Medical Sciences ◽  
Maternal Complications ◽  
Perinatal Mortality Rate ◽  
Increased Risk ◽  
Twin Pregnancies ◽  
Singleton Pregnancies

Background: Multiple pregnancies are associated with an increased risk of obstetric complications as well as perinatal morbidity and mortality especially in developing countries. The present study aims to understand the maternal and perinatal outcomes of multiple and singleton pregnancies delivering at Rajendra Institute of Medical Sciences, Ranchi, India. Aim of study was to investigate the maternal and fetal outcome in twin pregnancies in Rajendra Institute of Medical Sciences (RIMS), RanchiMethods: This comparative prospective study was conducted in the department of obstetrics and gynecology, Rajendra Institute of Medical Sciences, Ranchi from the period of 1st April 2015 to 30th September 2016. Consecutive sampling was done till the sample size of 75 was reached for both twin and singleton pregnancies. It included all women admitted in antenatal ward and labor room with clinical or ultrasound diagnosis of twin pregnancy after 28 weeks of gestation.Results: The incidence of twins in this study was 1.85%. Mean maternal age was 25.25±4.5 years for twin pregnancies and 23.53 ± 3.3 for singleton pregnancies. Twins were seen more in multigravida (70.7%) as compared to primigravida (29.3%). Preterm labor (74.7%), anemia (44%) and hypertensive disorders (32%) and PPH (13.33%) were the most common complication in twin pregnancies. Significantly higher rate of LSCS were seen in twin pregnancies (32.67%) as compared to singletons 18.67%. Mean weight of first twin was 2.03±0.52kg and for second twin it was 1.98±0.51kg. There was higher incidence of moderate to severe asphyxia, IUGR and higher rate of NICU admissions in twins as compared to singletons. Perinatal mortality rate of monchrionic pregnancy was 30% and it was 10.2% for dichorionic pregnancy which shows a significant association of perinatal mortality rate and chorionicity.Conclusions: Good antenatal care, with increased rest and nutritional supplementation, early detection of fetal and maternal complications together with thorough intranatal and postnatal vigilance, can lower both maternal and fetal dangers.

scholarly journals Clinical Efficiency of Non-invasive Prenatal Screening for Common Trisomies in Low-Risk and Twin Pregnancies

2021 ◽  
Vol 12 ◽  
Author(s):  
Yanfei Xu ◽  
Pengzhen Jin ◽  
Yu Lei ◽  
Yeqing Qian ◽  
Yuqing Xu ◽  
...  
Keyword(s):  
High Risk ◽  
Predictive Value ◽  
Prenatal Screening ◽  
Low Risk ◽  
Trisomy 13 ◽  
Non Invasive ◽  
Clinical Efficiency ◽  
Sensitivity Specificity ◽  
Twin Pregnancies ◽  
Singleton Pregnancies

To evaluate the clinical efficiency of non-invasive prenatal screening (NIPS) for fetal aneuploidies in low-risk and twin pregnancies, patients who received NIPS in a tertiary university hospital were enrolled, and their clinical data, NIPS results and pregnancy outcomes were collected. Patients were divided into singleton and twin pregnancies, and then those with singleton pregnancies were divided into low- and high-risk pregnancies. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated. Comparisons were made on the clinical efficiency of NIPS between singleton and twin pregnancies, as well as between low- and high-risk pregnancies. Of 66,172 patients enrolled, 59,962 were eligible for analysis. The sensitivity, specificity and NPV were ≥ 99% in singleton and twin pregnancies. The PPVs were 90.4, 56.6, and 13.0% in singleton pregnancies, while 100, 33.3, and 0% in twin pregnancies for trisomy 21 (T21), trisomy 18 (T18) and trisomy 13 (T13), respectively (P &gt; 0.05 for all). The PPVs were 97.4 and 90.0% in high-risk pregnancies, while 78.6 and 16.7% in low-risk pregnancies for T21 and T18, respectively (P &lt; 0.05 for all). In summary, the performance of NIPS in singleton pregnancies was similar to that in twin pregnancies. NIPS can be recommended for all pregnancies regardless of the risks.

Accuracy of a combined insulin-like growth factor-binding protein-1/interleukin-6 test (Premaquick) in predicting delivery in women with threatened preterm labor

2017 ◽  
Vol 45 (8) ◽  
Author(s):  
George Uchenna Eleje ◽  
Euzebus Chinonye Ezugwu ◽  
Ahizechukwu Chigoziem Eke ◽  
Lydia Ijeoma Eleje ◽  
Joseph Ifeanyichukwu Ikechebelu ◽  
...  
Keyword(s):  
Growth Factor ◽  
Interleukin 6 ◽  
Predictive Value ◽  
Preterm Labor ◽  
Predictive Accuracy ◽  
Binding Protein ◽  
Insulin Like Growth Factor ◽  
Factor Binding ◽  
Threatened Preterm Labor ◽  
Singleton Pregnancies

AbstractPurpose:To determine values of combinations of interleukin-6 (IL-6)/cervical native insulin-like growth factor-binding protein-1 (IGFBP-1)/total IGFBP-1 (Premaquick©) in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in women with threatened preterm labor.Methods:Women with singleton pregnancies between gestation age (GA) of 24 weeks and 36 weeks and 6 days with preterm labor were recruited during a prospective multicenter study. Premaquick© was positive when at least two of three biomarkers were positive. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were estimated for both prediction of spontaneous deliveries and spontaneous exclusive preterm deliveries.Results:Ninety-seven (99.0%) out of 98 women enrolled were analyzed. Based on delivery status 7/14 days post-enrollment of general study population, Premaquick© had a sensitivity of 87.1/85.7%, a specificity of 92.4/96.8%, a PPV of 84.4/93.8% and a NPV of 93.9/92.3% for prediction of spontaneous delivery. Predictive accuracy of Premaquick© test in relation to days of enrollment were: 90.7% (≤7 days) and 92.8% (≤14 days). For women enrolled at GA <35 weeks, Premaquick© had a sensitivity of 100.0/87.5%, a specificity of 94.1/96.9%, a PPV of 70.5/87.5%, a NPV of 100.0/96.9% and an accuracy of 95.0/95.0% for prediction of preterm delivery within 7/14 days of enrollment, respectively. PPV was most significantly different in both groups when outcomes were compared between 2 days and 14 days post-enrollment (P<0.001).Conclusion:This novel triple biomarker model of native and total IGFBP-1 and IL-6 appears to be an accurate test in predicting spontaneous deliveries and spontaneous exclusive preterm deliveries in threatened preterm labor in singleton pregnancies.

Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

2020 ◽  
Author(s):  
Florian Matthias Stumpfe ◽  
Florian Faschingbauer ◽  
Sven Kehl ◽  
Jutta Pretscher ◽  
Julius Emons ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Adverse Perinatal Outcome ◽  
Adverse Perinatal Outcomes ◽  
Nicu Admission ◽  
Singleton Pregnancies

Abstract Purpose Introduction of a novel ratio – the amniotic-umbilical-to-cerebral ratio (AUCR) – to predict adverse perinatal outcome in SGA fetuses at term and comparison of its predictive accuracy with established parameters. Materials and Methods This retrospective cohort study included 165 singleton pregnancies with SGA fetuses (birth weight < 10th percentile) at term. Cases with planned vaginal delivery and documented pulsatility indices (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and single deepest pocket (SDP) were included. CPR was calculated as the ratio between MCA PI and UA PI, UCR as the ratio between UA PI and MCA PI. AUCR was defined as follows: SDP/(UA PI/MCA PI). Adverse perinatal outcomes were defined as operative intervention (OI), OI due to fetal distress, admission to the neonatal intensive care unit (NICU), and composite adverse perinatal outcome (CAPO). Associations between Doppler parameters and these outcomes were estimated using regression analyses. Results OI was statistically significantly associated with UCR, SDP, and AUCR, whereas no association was observed for UA PI, MCA PI, and CPR. Fetuses requiring OI due to fetal distress revealed a significantly higher UA PI and UCR as well as a lower MCA PI, CPR, and AUCR. With regard to NICU admission and CAPO, a significantly higher UA PI and lower CPR were found. Furthermore, a significant association was shown for SDP, UCR, and AUCR. AUCR achieved the best area under the curve for all outcome parameters. Conclusion AUCR leads to an improvement in the prediction of unfavorable outcome in SGA fetuses at term. Furthermore, results of our study show that UCR might be superior to CPR.

Detection of Falsely Elevated Point-of-Care Potassium Results Due to Hemolysis Using Predictive Analytics

2020 ◽  
Vol 154 (2) ◽  
pp. 242-247
Author(s):  
Robert C Benirschke ◽  
Thomas J Gniadek
Keyword(s):  
Machine Learning ◽  
Predictive Value ◽  
Predictive Analytics ◽  
Point Of Care ◽  
Area Under The Curve ◽  
Plasma Potassium ◽  
Data Set ◽  
Laboratory Errors ◽  
Rule Out

Abstract Objectives Preanalytical factors, such as hemolysis, affect many components of a test panel. Machine learning can be used to recognize these patterns, alerting clinicians and laboratories to potentially erroneous results. In particular, machine learning might identify which cases of elevated potassium from a point-of-care (POC) basic metabolic panel are likely erroneous. Methods Plasma potassium concentrations were compared between POC and core laboratory basic metabolic panels to identify falsely elevated POC results. A logistic regression model was created using these labels and the other analytes on the POC panel. Results This model has high predictive power in classifying POC potassium as falsely elevated or not (area under the curve of 0.995 when applied to the test data set). A rule-in and rule-out approach further improves the model’s applicability with a positive predictive value of around 90% and a negative predictive value near 100%. Conclusions Machine learning has the potential to detect laboratory errors based on the recognition of patterns in commonly requested multianalyte panels. This could be used to alert providers at the POC that a result is suspicious or used to monitor the quality of POC results.

scholarly journals Gestational Age-Specific Reference Ranges for the sFlt-1/PlGF Immunoassay Ratio in Twin Pregnancies

2021 ◽  
pp. 1-9
Author(s):  
Maria De La Calle ◽  
Juan L. Delgado ◽  
Stefan Verlohren ◽  
Ana Isabel Escudero ◽  
Jose L. Bartha ◽  
...  
Keyword(s):  
Specific Reference ◽  
Reference Ranges ◽  
Range Analysis ◽  
Short Term ◽  
Term Outcome ◽  
Twin Pregnancies ◽  
Plgf Ratio ◽  
Control Study ◽  
Normal Twin ◽  
Singleton Pregnancies

<b><i>Objective:</i></b> Establish reference ranges for the Elecsys® soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) immunoassay ratio in twin pregnancies. <b><i>Methods:</i></b> Data analyzed were from 3 prospective studies: Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia (PE) (PROGNOSIS), Study of Early-onset PE in Spain (STEPS), and a multicenter case-control study. Median, 5th, and 95th percentiles for sFlt-1, PlGF, and the sFlt-1/PlGF ratios were determined for normal twin pregnancies for 7 gestational windows and compared with the previous data for singleton pregnancies. <b><i>Results:</i></b> The reference range analysis included 269 women with normal twin pregnancies. Before 29 weeks’ gestation, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios did not differ between twin and singleton pregnancies. From 29 weeks’ gestation to delivery, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios were substantially higher in twin versus singleton pregnancies. sFlt-1 values were higher in women with twin pregnancies across all gestational windows. PlGF values were similar or higher in twin versus singleton pregnancies; PlGF concentrations increased from 10 weeks + 0 days to 28 weeks + 6 days’ gestation. <b><i>Conclusions:</i></b> Reference ranges for the sFlt-1/PlGF ratio are similar in women with twin and singleton pregnancies until 29 weeks’ gestation but appear higher in twin pregnancies thereafter.

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