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Position Statement
Consensus statement on the potential implementation of the sFlt-1/PlGF ratio in women with suspected pre-eclampsia
Abstract
Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity worldwide, and places a significant burden on the South African (SA) healthcare system. The soluble fms-like tyrosince kinase (sFlt-1)/placental growth factor (PlGF) ratio can serve as a diagnostic aid for PE, and should be used in combination with clinical judgement and other ancillary tests. The Preeclampsia Advisory Board was convened on 31 March 2017, with experts in the field of PE from various hospitals and universities around the country in attendance. An international expert gave insight into best practices from countries that have implemented the Elecsys immunoassay sFlt-1/PlGF ratio. Others recommend that the sFlt-1/PlGF ratio be implemented in clinical practice when clinical diagnosis is in doubt in patients with suspected PE, in the interests of avoiding unnecessary hospitalisation and interventions. The strength of the test lies in its negative predictive value in ruling out PE. Ruling out PE could drive cost savings, as fewer women would be needlessly admitted to hospital, and there could, in addition, be fewer iatrogenic preterm deliveries, which are associated with considerable morbidity and cost. As most data are derived from high-income countries, multicentre studies are required to assess the clinical performance of this test within the context of SA.
Authors' affiliations
M Matjila, Department of Obstetrics and Gynaecology, Groote Schuur Hospital and University of Cape Town, South Africa; Receptor Biology Unit, Division of Medical Biochemistry, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
J Anthony, Department of Obstetrics and Gynaecology, Groote Schuur Hospital and University of Cape Town, South Africa
M Vatish, Nuffield Department of Women’s & Reproductive Health, University of Oxford, UK
J Moodley, Department of Obstetrics and Gynaecology, Women’s Health and HIV Research Group, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
I Bhorat, Department of Obstetrics and Gynaecology, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
E Nicolaou, Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa; Morningside MediClinic, Johannesburg, South Africa
P Soma-Pillay, Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital and University of Pretoria, South Africa
S Monokoane, Department of Obstetrics and Gynaecology, Dr George Mukhari Hospital and Sefako Makgatho Health Sciences University, Pretoria, South Africa
H Lombaard, Department of Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa
L Chauke, Department of Obstetrics and Gynaecology, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa, National Health Laboratory Services
T Pillay, Department of Chemical Pathology, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa, and National Health Laboratory Services
E Mokaba, Woman, Maternal and Reproductive Health, National Department of Health, South Africa
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Date published: 2018-12-03
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