Preeclampsia
Conditions
Keywords
Preeclampsia, pregnancy, biomarkers, prediction, safety, cost
Brief summary
The aim of the PRECOG study is to determine in a prospective interventional randomized study whether the implementation of a predictive test based on the sFLT-1/PlGF ratio improves perinatal care and reduces costs, in patients with suspected preeclampsia before 35 weeks of gestation.
Detailed description
Preeclampsia is a hypertensive disorder of pregnancy associated with placental insufficiency and is one of the major important of prematurity and maternal mortality worldwide. It complicates 2 to 7% of pregnancies. It is currently considered that preeclampsia is associated with maternal endothelial dysfunction induced by the release into the maternal circulation of excess placental factors (such as sFLT-1 a soluble receptor for VEGF and PlGF). There is currently no curative treatment, and only childbirth and delivery of the placenta alleviate the mother's symptoms. Moreover, the evolution from case with mild symptoms to a severe case of preeclampsia is often is often rapid and difficult to anticipate. Therefore, it is recommended to manage patients with preeclampsia in hospital and cases of suspected preeclampsia are usually admitted in prenatal units. Each year thousands of patients are hospitalized for surveillance and blood/urine analysis to rule out the diagnosis of preeclampsia. A biological test to predict preeclampsia would therefore be of particular interest in order to: * identify patients without preeclampsia and therefore void costs and iatrogenic complications related to unnecessary hospitalization * identify patients at high risk of maternal and perinatal complications in order to anticipate in utero transfer, optimize maternal and fetal surveillance and administrate steroids. It has recently been demonstrated that sFLT-1 and PlGF have a high predictive value for the diagnosis and the prediction of preeclampsia, but the interest of introducing these markers in clinical practice has not been demonstrated yet. The diagnostic and predictive value of the sFlt-1/PlGF ratio in patients at risk of placenta-related disorders has been shown in the recent literature and estimation of the sFlt-1/PlGF ratio has become an additional tool in the management of these disorders, primarily PE. This ratio can distinguish the patients that develop maternal or perinatal complications in the next 7-14 days from those with uncomplicated pregnancy. Women with an sFlt-1/PlGF ratio\<38 do not have PE at the time of the test and in all likelihood will not develop PE for at least 1week; it is thereby of great value for reassuring the clinician and the patient. Up to 80% of patients are supposed to be in this patient group; therefore, clinicians are able to exclude the majority of patients and focus on those who need more attention and care. On contrary women with a sFlt-1/PlGF ratio \> 38 and more specifically those with a ratio over 85 are highly likely to develop preeclampsia and should be managed according to local practice/guidelines. Thus the use of such predictive tool appear very promising but its interest has not been demonstrated in prospective intervention studies. The aim of the PRECOG study is to determine in a prospective interventional randomized study whether the implementation of a predictive test based on the sFLT-1/PlGF ratio improves perinatal care and reduces costs, in patients with suspected preeclampsia before 35 WG. costs, in patients with suspected preeclampsia before 35 WG.
Interventions
BIOLOGICALsFlt-1 / PlGF ratio
* Ambulatory management if sFlt-1 / PlGF ratio is below 38 * usual management if sFlt-1/PlGF is between 38 and 85. * If the ratio is \> 85, monitoring will be intensified and patient hospitalization will be continued
Sponsors
Assistance Publique - Hôpitaux de Paris
Institut National de la Santé Et de la Recherche Médicale, France
URC-CIC Paris Descartes Necker Cochin
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patient hospitalized for suspected preeclampsia between 24WG+ 0 days and 35WG + 6 days, Patiente with at least one of the following criteria: * Arterial hypertension defined by systolic BP ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg * Proteinuria greater than 0.3g / 24h or 0.3g / l or ≥ 3+ * Proteinuria / creatinine ratio ≥ 30 mg / mmol * Pain in the epigastric bar * Generalized edema * Hepatic cytolysis\> 1.5N * Thrombocytopenia \<150000 / mm3 Informed consent signed by both parties Non-opposition was accepted by parental authority Age ≥ 18 years
Exclusion criteria
Diagnosis of preeclampsia (arterial pressure\> 140/90 and proteinuria\> 0.3g / 24h or urine test\> 3+) or complete HELLP syndrome (Platelets \<100000 / mm3 and SGOT\> 2N and LDH and collapsed Haptoglobin) IUGR with absent or reverse diastolic umbilical flow Fetal heart rate abnormalities Gestational age \<24 WG and\> 35 WG Multiple pregnancy Patient without health insurance Non-consent of patient Minor patient Congenital malformation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| number of patients hospitalised for more than 24 hours | up to 12 weeks | Duration in hours, from admission to discharge from hospital at initial hospitalisation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Maternal and fetal morbidity | up to 13 weeks | severe preeclampsia, eclampsia, HELLP syndrome, Disseminated intravascular coagulation, abruptio placenta, delivery before 34 WA, IUGR\< 3°P, Fetal death |
| Maternal morbidity | up to 13 weeks | High blood pressure, preeclampsia, caesarean section, postpartum hemorrhage\> 500 ml |
| Severe Maternal morbidity (Composite outcome ) | up to 13 weeks | eclampsia, HELLP syndrome, Disseminated intravascular coagulation, Abruption placenta |
| Number of days between randomisation and delivery | up to 12 weeks | Number of days between randomisation and delivery |
| Mode of delivery | At delivery | Cesarean, vaginal delivery |
| Gestational age | at delivery | Gestational age at delivery |
| Birth weight centile | At delivery | Centile of birth weight |
| Fetal death | up to 13 weeks | Fetal death diagnosed at ultrasound before delivery |
| Prematurity before 37 WG | up to 13 weeks | Delivery before 37 WG + 0 days |
| Prematurity before 34 WG | Delivery | Delivery before 34 WG + 0 days |
| Prematurity before 32 WG | Delivery | Delivery before 32 WG + 0 days |
| Perinatal morbidity (Composite outcome) | At delivery | prematurity, birth weight \<10 ° P |
| Severe Perinatal morbidity (Composite outcome) | At delivery | perinatal mortality, prematurity \<34 SA, birth weight \<3 ° P |
| Costs | up to 14 weeks | direct costs of prenatal care, direct costs of neonatal care, total costs |
| Satisfaction form | Day 3 after delivery | Satisfaction concerning the management of pregnancy and duration of hospitalisation |
Countries
France
Contacts
STUDY_CHAIRJean GUIBOURDENCHE, MD, PhD
Assistance Publique - Hôpitaux de Paris
Outcome results
None listed