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Comparison of two test systems for sFlt-1 and PlGF – diagnostic accuracy for preeclampsia
Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 206 (2016) e1–e127
Pre-eclampsia, HELLP, TTP and HUS
Fetal monitoring
Oral Presentation
No Preference
Comparison of two test systems for sFlt-1 and PlGF – diagnostic accuracy for preeclampsia
Perinatal risk factors for newborn babies undergoing cooling-lessons learnt
Lisa Antonia Droege 1,∗ , Vanessa Schwarz 1 , Alice Höller 1 , Laura Ehrlich 1 , Stefan Verlohren 1 , Wolfgang Henrich 1 , Frank Holger Perschel 2
Edwina Goh ∗ , Nicola Robinson, Maheswari Srinivasan
1
Department of Obstetrics, Campus Mitte, Charité University Medicine, Berlin, Germany 2 Department of Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry, Charité University Medicine, Berlin, Germany and Labor Berlin – Charité Vivantes GmbH, Berlin, Germany E-mail address: [email protected] (L.A. Droege).
Objective: The angiogenic factors sFlt-1, PlGF and the sFlt1/PlGF-ratio have shown utility as a diagnostic test for preeclampsia (PE). Previous case control studies have determined cut-off values for sFlt-1 and PlGF with the Elecsys® assay (Roche Diagnostics). The objective of this study was to characterize angiogenic factor levels of sFlt-1, PlGF and sFlt-1/PlGF-ratio measured with the Kryptor® immunoassay (ThermoFisher Scientific) in normal and preeclamptic singleton pregnancies. Methods: In a cohort of n = 208 women, sFlt-1 and PlGF was measured with Kryptor® and ELECSYS® immunoassays. In the longitudinal arm of the study, sFlt-1 and PlGF were determined in n = 262 samples of n = 180 patients with an uneventful pregnancy outcome to generate normal ranges. A gestational-age matched comparison between n = 28 cases with preeclampsia (PE) and n = 108 controls in the third trimester was performed and a ROC analysis was executed to test and compare the diagnostic accuracy. Results: In patients with PE, sFlt-1 and the sFlt-1/PlGF ratio were significantly increased and PlGF was significantly decreased as compared to healthy controls (median (IQR) sFlt-1: 7664 pg/ml (6652 pg/ml) vs. 2365 pg/ml (2505 pg/ml), p < 0.001; sFlt-1/PlGF: 235.4 (381.7) vs. 13.78 (37.22), p < 0.001; PlGF: 36.86 pg/ml (26.72 pg/ml) vs. 160.40 pg/ml (258.5 pg/ml), p < 0.001). With an area under the curve of 0.930 when diagnosing PE, ROC analysis yielded an optimal cut-off at 103 with a sensitivity of 89.3% and a specificity of 90.7% when analysing the sFlt-1/PlGF ratio. The established cut-off values for Elecsys® at 38 and 85 when analysing the sFlt-1/PlGF ratio with the Kryptor® assay, result in a sensitivity of 92.9% and 89.3% and in a specificity of 72.2% and 87%. Conclusion: Performing the sFlt-1/PlGF ratio with the immunoassay Kryptor® by Thermo Scientific diagnoses PE with a diagnostic accuracy comparable to the cut-off values established with Elecsys® assays. http://dx.doi.org/10.1016/j.ejogrb.2016.07.110
e33
City Hospital, Sandwell and West Birmingham Hospitals NHS trust, Birmingham, UK E-mail address: [email protected] (E. Goh). Introduction: According to the RCOG Each Baby Counts, each year between 500 and 800 babies die or are left with severe brain injury – not because they are born too soon or too small, or have a congenital abnormality, but because something goes wrong during labour. In our hospital we have a robust risk management team looking at the unexpected neonatal admissions to the neonatal unit for cooling, as cooling reduces babies born with hypoxic ischaemic encphelopathy with long term neurological sequelae. Our aim is to look at their root cause analysis and the lessons learnt from them. Aim: To look at all term neonates who were transferred from Delivery Suite to our Neonatal Unit and who underwent cooling from 1st January 2015 until 31st December 2015 for a period of one year. We looked at the root cause analysis and lessons learnt from them. Materials and methods: Retrospective case note analysis of all the mothers whose newborns underwent cooling in the year 2015 and looked at the RCA reports. Results: There were around 6000 births during this time period and 16 babies were born with low Apgars and underwent cooling, giving an approximate of 2.66/1000 births. Babies were born with Apgars of 0–7 in 5 min. Arterial PH was from 6.50 to 7.29 (average of 6.90). Maternal risk factors: 12/16 75% received high risk, obstetric care in view of the risk assessment in the antenatal period, smoking: 4/16 – 25%, previous cesarean section: 6/16 – 37.5%, meconium stained liquor: 3/16 – 18.75%, abruption: 3/16 – 18.75%, ruptured uterus: 2/16 – 12.5%. Majority of the babies were delivered by cesarean section 75%. Conclusion: We could not have prevented all cases of intra partum asphyxia. There are few cases of the CTG misinterpretation which might have contributed to the poor neonatal outcomes. Patients with previous caesarean section and 2 successful vaginal births after caesarean section (VBAC) still has increased risk of scar dehiscence, hence syntocinonon should be use cautiously for augmentation of labour. RCOG wants to reduce the incidence of intra partum asphyxia by 50% by 2020. http://dx.doi.org/10.1016/j.ejogrb.2016.07.111
Pre-eclampsia, HELLP, TTP and HUS
Fetal monitoring
Oral Presentation
No Preference
Comparison of two test systems for sFlt-1 and PlGF – diagnostic accuracy for preeclampsia
Perinatal risk factors for newborn babies undergoing cooling-lessons learnt
Lisa Antonia Droege 1,∗ , Vanessa Schwarz 1 , Alice Höller 1 , Laura Ehrlich 1 , Stefan Verlohren 1 , Wolfgang Henrich 1 , Frank Holger Perschel 2
Edwina Goh ∗ , Nicola Robinson, Maheswari Srinivasan
1
Department of Obstetrics, Campus Mitte, Charité University Medicine, Berlin, Germany 2 Department of Laboratory Medicine, Clinical Chemistry, and Pathobiochemistry, Charité University Medicine, Berlin, Germany and Labor Berlin – Charité Vivantes GmbH, Berlin, Germany E-mail address: [email protected] (L.A. Droege).
Objective: The angiogenic factors sFlt-1, PlGF and the sFlt1/PlGF-ratio have shown utility as a diagnostic test for preeclampsia (PE). Previous case control studies have determined cut-off values for sFlt-1 and PlGF with the Elecsys® assay (Roche Diagnostics). The objective of this study was to characterize angiogenic factor levels of sFlt-1, PlGF and sFlt-1/PlGF-ratio measured with the Kryptor® immunoassay (ThermoFisher Scientific) in normal and preeclamptic singleton pregnancies. Methods: In a cohort of n = 208 women, sFlt-1 and PlGF was measured with Kryptor® and ELECSYS® immunoassays. In the longitudinal arm of the study, sFlt-1 and PlGF were determined in n = 262 samples of n = 180 patients with an uneventful pregnancy outcome to generate normal ranges. A gestational-age matched comparison between n = 28 cases with preeclampsia (PE) and n = 108 controls in the third trimester was performed and a ROC analysis was executed to test and compare the diagnostic accuracy. Results: In patients with PE, sFlt-1 and the sFlt-1/PlGF ratio were significantly increased and PlGF was significantly decreased as compared to healthy controls (median (IQR) sFlt-1: 7664 pg/ml (6652 pg/ml) vs. 2365 pg/ml (2505 pg/ml), p < 0.001; sFlt-1/PlGF: 235.4 (381.7) vs. 13.78 (37.22), p < 0.001; PlGF: 36.86 pg/ml (26.72 pg/ml) vs. 160.40 pg/ml (258.5 pg/ml), p < 0.001). With an area under the curve of 0.930 when diagnosing PE, ROC analysis yielded an optimal cut-off at 103 with a sensitivity of 89.3% and a specificity of 90.7% when analysing the sFlt-1/PlGF ratio. The established cut-off values for Elecsys® at 38 and 85 when analysing the sFlt-1/PlGF ratio with the Kryptor® assay, result in a sensitivity of 92.9% and 89.3% and in a specificity of 72.2% and 87%. Conclusion: Performing the sFlt-1/PlGF ratio with the immunoassay Kryptor® by Thermo Scientific diagnoses PE with a diagnostic accuracy comparable to the cut-off values established with Elecsys® assays. http://dx.doi.org/10.1016/j.ejogrb.2016.07.110
e33
City Hospital, Sandwell and West Birmingham Hospitals NHS trust, Birmingham, UK E-mail address: [email protected] (E. Goh). Introduction: According to the RCOG Each Baby Counts, each year between 500 and 800 babies die or are left with severe brain injury – not because they are born too soon or too small, or have a congenital abnormality, but because something goes wrong during labour. In our hospital we have a robust risk management team looking at the unexpected neonatal admissions to the neonatal unit for cooling, as cooling reduces babies born with hypoxic ischaemic encphelopathy with long term neurological sequelae. Our aim is to look at their root cause analysis and the lessons learnt from them. Aim: To look at all term neonates who were transferred from Delivery Suite to our Neonatal Unit and who underwent cooling from 1st January 2015 until 31st December 2015 for a period of one year. We looked at the root cause analysis and lessons learnt from them. Materials and methods: Retrospective case note analysis of all the mothers whose newborns underwent cooling in the year 2015 and looked at the RCA reports. Results: There were around 6000 births during this time period and 16 babies were born with low Apgars and underwent cooling, giving an approximate of 2.66/1000 births. Babies were born with Apgars of 0–7 in 5 min. Arterial PH was from 6.50 to 7.29 (average of 6.90). Maternal risk factors: 12/16 75% received high risk, obstetric care in view of the risk assessment in the antenatal period, smoking: 4/16 – 25%, previous cesarean section: 6/16 – 37.5%, meconium stained liquor: 3/16 – 18.75%, abruption: 3/16 – 18.75%, ruptured uterus: 2/16 – 12.5%. Majority of the babies were delivered by cesarean section 75%. Conclusion: We could not have prevented all cases of intra partum asphyxia. There are few cases of the CTG misinterpretation which might have contributed to the poor neonatal outcomes. Patients with previous caesarean section and 2 successful vaginal births after caesarean section (VBAC) still has increased risk of scar dehiscence, hence syntocinonon should be use cautiously for augmentation of labour. RCOG wants to reduce the incidence of intra partum asphyxia by 50% by 2020. http://dx.doi.org/10.1016/j.ejogrb.2016.07.111