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Title: Use of third trimester serum biomarkers and ultrasound paameters to predict the small for gestational age infant at delivery
Author: Griffin, Melanie Joanne
ISNI:       0000 0004 5368 4805
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2015
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Current techniques to identify growth-restricted fetuses, at risk of health complications, have limited accuracy. Placental insufficiency is a key pathological process in fetal growth restriction (FGR). I investigated the potential clinical benefit of placental biomarkers to identify pregnancies delivering small for gestational age (SGA) infants in pregnancies with suspected pre-eclampsia and in those with reduced symphysis-fundal height measurement using delivery of an SGA infant as a surrogate measure of FGR. Suspected pre-eclampsia (PELICAN-PE study) In a large multicentre prospective cohort study investigating diagnostic accuracy of placental growth factor (PlGF) in women with suspected pre-eclampsia, I assessed test performance of 47 biomarkers and ultrasound parameters to identify women delivering an SGA infant. PlGF measurement outperformed all other biomarkers and currently used tests in predicting delivery of an SGA infant. Combinations of biomarkers added minimal value. Reduced symphysis-fundal height measurement (PELICAN-FGR study) I assessed the ability of PlGF and ultrasound parameters to predict delivery of an SGA infant in women with reduced symphysis-fundal height (current UK standard to identify pregnancies at risk of SGA) in a second multinational prospective cohort study. Test performance statistics were calculated for all parameters in isolation and combination. Ultrasound parameters had modest test performance for predicting delivery of an SGA infant. PlGF performed no better. Incorporating PlGF with ultrasound parameters provided modest improvements. In women presenting with suspected pre-eclampsia, PlGF measurement is a potentially useful adjunct to current practice in identifying those at risk of SGA. The findings of the PELICAN-FGR study cannot support the use of PlGF to risk stratify women referred with reduced symphysis-fundal height. The prevalence of FGR in the two studies differed, with a high number of normal pregnancies in those presenting with reduced symphysis-fundal height. The pathological process in normotensive versus hypertensive SGA may differ, potentially explaining these findings.
Supervisor: Shennan, Andrew Hoseason ; Chappell, Lucy Charlotte Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available