Use this URL to cite or link to this record in EThOS:
Title: Assessment and stratification of women with hypertension in the second half of pregnancy : a clinical, biochemical, economical and outcome evaluation
Author: Duckworth, Susan Jacqueline
ISNI:       0000 0004 5994 5842
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2016
Availability of Full Text:
Access from EThOS:
Access from Institution:
Pre-eclampsia is a disease unique to pregnancy. Prevalence in the UK is between 5- 8% of pregnancies yet diagnosis remains challenging. The PELICAN study was a multi-centre, observational cohort study. The primary aim was to evaluate the diagnostic accuracy of plasma placental growth factor (PlGF) in the second half of pregnancy, in predicting the need for delivery for pre-eclampsia within 14 days of testing. 649 women presenting with suspected pre-eclampsia were recruited between January 2011 and February 2012, across seven consultant-led units within England and Ireland. Blood samples were taken at enrolment; PlGF measurements were performed but results blinded until the study was complete and diagnoses and pregnancy outcome known. A further 47 biomarkers were measured (using 57 assays) to evaluate whether the diagnostic potential of PlGF could be improved further. Using a pre-specified cut off of <5th centile, a low (>12pg/ml < 5th centile) or very low (<12pg/ml) PlGF concentration was shown to have high sensitivity (0.95 CI (0.89- 0.99) in women < 35 weeks’ gestation) to determine need for delivery within 14 days. When compared with other biologically plausible biomarkers, the area under the ROC curve for low or very low PlGF (0.87, standard error 0.03), was greater than all other commonly utilised tests either singly or in combination (range 0.58–0.76; p<0.001 for all comparisons). Data from 100 women were then used to perform a budget impact analysis. A hypothetical decision analytical model using data extracted from case note review and reference cost tariffs, suggested a mean cost saving associated with the PlGF test (in the PlGF plus management arm) of £35,087 (95% CI -£33,181 to -£36,992) per 1,000 women, equating to a saving of £582 (95% CI -£552 to -£613) per woman tested. PlGF testing could be used to risk-stratify women with suspected pre-eclampsia with the aim of improving pregnancy outcome.
Supervisor: Shennan, Andrew Hoseason ; Chappell, Lucy Charlotte Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available