RCT Results: Does Including PIGF Testing in Preeclampsia Assessment Reduce Morbidity?
BACKGROUND AND PURPOSE:
Abnormal placental growth factor (PlGF) may be useful as a diagnostic biomarker for preeclampsia, but has yet to be incorporated into guidelines due to lack of evidence regarding clinical utility
Hayes-Ryan et al. (BMJ, 2021) assessed whether the addition of PIGF to current clinical practice in the setting of preeclampsia before 37 weeks could improve outcomes
Stepped wedge cluster randomized control trial
Trial conducted in Ireland
7 largest maternity units in Ireland
Singleton pregnancy between 20w0d and 36w6d
Signs or symptoms suggestive of evolving preeclampsia
Usual care only
Usual care plus point-of-care PlGF testing
Each maternity hospital acted as a cluster | All clusters started as a control and then transitioned at random to PlGF intervention at pre-specified time points
Usual care: Based upon NICE guidelines for preterm preeclampsia
Point-of care PlGF: Increased investigation and frequency of review for abnormal or highly abnormal PlGF result (<100 pg/mL and <12 pg/mL respectively) | Final decisions including when to deliver based on clinician’s judgement
Analysis was on an individual participant level using mixed-effects Poisson regression adjusted for time effects by intention-to-treat
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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