Recent publications

INSIGHT Study

Title: Predictive RNA profiles for early and very early spontaneous preterm birth

Aim of the study:

  • To assess whether cell free RNA (cfRNA) biomarkers in the plasma is a useful molecular test for predicting spontaneous preterm birth (sPTB)

 Results:

  • 242 pregnant women
  • 25 RNA transcripts were identified showing an association with sPTB
  • cfRNA showed high predictability for sPTB in an ethnically diverse population
  • cfRNA predicted sPTB in both early (<35 weeks) and very early (<25 weeks) sPTB 
  • Very early sPTB was associated with genes related to insulin-like growth transport and amino acid metabolism pathways
  • Early sPTB was associated with genes involved in extracellular matrix degradation and remodelling 

 Conclusion

  • Introduction of plasma screening tests can help with predicting sPTB in high risk women 
  • Understanding RNA profiles in maternal plasma can help better understand the mechanisms behind preterm birth 

PARROT Study

Title: Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial

Aim of the study:

  • To assess whether PlGF concentrations helped to decrease the time for clinicians to make a diagnosis of pre-eclampsia
  • To assess whether PlGF reduced maternal and perinatal adverse outcomes

 Results:

  • 1023 women
  • Low PlGF <100pg/Ml
    • High accuracy in determining pre-eclampsia that required delivery within 14 days
    • <35 weeks: sensitivity 94.9%, negative predictive value 98.3%
    • 35-36+6: sensitivity 96.2%, negative predictive value 97.1%
  • Time to diagnose pre-eclampsia
    • Revealed testing: 1.9 days
    • Concealed testing: 4.1 days
    • 64% reduction in time to diagnosis p=0.027
  • Severe maternal advere outcomes
    • Less frequent in revealed testing group than conealed p=0.043

 Conclusion

  • PlGF measurements can help clinicians diagnose pre-eclampsia in a more timely manner in women presenting with suspected pre-eclampsia leading to a significant reduction in maternal adverse outcomes

PHOENIX Study

Title: Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial

Aim of the study:

  • Compare planned early initiation of delivery vs. expectant management in women with pre-eclampsia between 34-37 weeks

 Results:

  • 901 women with late preterm pre-eclampsia
  • Primary maternal outcomes were significantly lower in planned delivery group (p=0..0005)
  • Primary perinatal outcomes were significantly higher in planned delivery group (p=00034)
  • Planned delivery group showed increased rates of spontaneous vaginal births 

 Conclusion

  •  Lower maternal morbidity but higher neonatal unit admission (but no additional respiratory or other morbitiy), consider planned delivery in some women with late preterm preeclampsia 

CRADLE 3

Title: Effect of a novel vital sign device on maternal mortality and morbidity in low-resource settings: a pragmatic, stepped-wedge, cluster-randomised controlled trial

Aim of the study:

  • Whether implementation of the CRADLE VSA device alongside an education package into the community and maternity facilities in low resource settings can reduce all cause maternal mortality and morbidity.

 Results:

  • 8% reduction in primary outcome (maternal death, eclampsia, hysterectomy) after intervention. P=0.0056 but not significant after adjusting for event trends in each cluster.
  • Significant reduction in rate of emergency hysterectomy post intervention = 0.0072

 Conclusion

  • The intervention was associated with a reduction in a composite of death, eclampsia, and hysterectomy but only hysterectomy was directly attributed to the intervention. The trial had insufficient power because of unexpected variation between clusters and despite the high number of primary outcome events.
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