Interest of sFlt1/PlGF Ratio at Obstetric Emergencies

Study Overview
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Brief Summary
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In patients with suspected placental vascular disease who do not require hospitalization, the use of the sFlt-1 (Soluble FMS like tyrosin-kinase-1)/PlGF (Placental Growth Factor)/ assay can most likely help teams to define the best possible management.

Detailed Description
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Preeclampsia is a serious obstetric condition, affecting 2 to 5% of pregnancies and associated with maternal hypertension and renal dysfunction. It is a constant concern of obstetrical teams in the pre and post partum period. In case of diagnosis in the emergency unit, patients are usually hospitalized. However, in the case of a diagnosis of preeclampsia has been invalidated, but in presence of isolated or frustrated clinical functional signs, in the case of a history of placental vascular pathology, obstetric teams implement surveillance strategies that are binding on the patients. The sFlt-1/ PlGF assay has a high negative predictive value for the coming week. The use in clinical practice of these two biomarkers in the indication of negative prediction at one week could help teams in their management but the interest of this use needs to be evaluated.

Official Title
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AngioCHIC : Interest of sFlt1/PlGF Ratio at Obstetric Emergencies

Conditions
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Suspected Placental Dysfunction, Ruled Out, Pregnancy Complications, Pre-Eclampsia

Intervention / Treatment
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* Diagnostic Test: Diagnostic test


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years old Pregnant patients term ≥ at 24 weeks of amenorrhoea (SA), Management in obstetrical emergencies and at the Centre Hopsitalier Intercommunal (CHI) de Créteil functional exploration center, with prescription of a vascular-renal check-up (BVR) ((proteinuria/creatinuria ratio, blood count, platelets, blood ionogram, creatinemia, transaminases (ASAT, ALAT), haptoglobulinemia, lactate dehydrogenase (LDH), TP). Presenting either one of the following isolated or associated clinical parameters: HyperTension urinary tape proteinuria functional signs of hypertension (headaches, phosphenes, accouphènes) live osteotendinous reflexes epigastric pains weight gain, lower limb edema, facial edema oliguria vomiting or one of the following isolated or associated ultrasound parameters: fetal hypotrophy, fetal growth deflection fetal Doppler abnormalities (umbilical Doppler, cerebral Doppler) ooligo-anamnios with intact membranes patient who has been informed and has given her oral non-opposition Exclusion Criteria: Diagnosis of preeclampsia Refusal of the patient Patient whose symptomatology (clinical or paraclinical) leads to a decision to be hospitalized Age < 18 years old Non-affiliation to the general social security system

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Diagnostic test|During a vascular check-up usually prescribed, an additional blood sample is taken to allow the determination of the sFlt1/PlGf ratio.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reconvening period in patients with an sFlt1 (Soluble FMS like tyrosin-kinase-1)/PlGF (Placental Growth Factor) ratio <38 (day) | At the end of pregnancy, calculation of the average time between the 1st consultation and the 1st reconvening in patients with an sFlt1/PlGF ratio <38, unknown during pregnancy, to determine if consultations could have been avoided. | trough participation period, an average of 4 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| reconvening period in patients with an sFlt1/PlGF ratio between 38 and 85 (day) | rate of reconvening | trough participation period, an average of 4 months | 
| reconvening period in patients with an sFlt1/PlGF ratio superior to 85 (day) | rate of reconvening | trough participation period, an average of 4 months | 
| blood pressure (mmHg) | Blood pressure higher than 140/90 mm Hg | trough participation period, an average of 4 months | 
| number of patients with functional signs of hypertension | phosphenes, accouphens, headaches, epigastric bar, edema | trough participation period, an average of 4 months | 
| number of patient with abnormal vascular and renal blood tests | platelets, transaminase, uric acid, ionogram | trough participation period, an average of 4 months | 
| proteinuria (mg/mmol) | urine protein-creatinine (P/C) ratio, mg/mmol | trough participation period, an average of 4 months | 
| Intra Uterine growth restriction (IUGR) | estimate foetal weight < 10 percentile or < 5 percentile | trough participation period, an average of 4 months | 
| fetal echography | umbilical and/or cerebral doppler | trough participation period, an average of 4 months | 
| term of delivery (weeks of gestation) | Analysis of term delivery with stratification by sFlt-1/PlGF ratio | at birth | 
| fetal weight at birth (g) | Analysis of fetal weight with stratification by sFlt-1/PlGF ratio | at birth | 
| number of hospitalized new born | Analysis of number of hospitalized new born with stratification by sFlt-1/PlGF ratio | at birth |