Postpartum Preeclampsia Early Detection and Treatment: Using Biomarkers to Implement Risk-stratified Intervention (Nepal Pilot Randomized Controlled Trial)
The goal of this study is to address the significant morbidity associated with preeclampsia diagnosed after delivery. All participants will undergo biomarker evaluation with soluble fms-like tyrosine kinase-1 and placental growth factor (sFlt-1/PlGF) ratio testing before delivery to assess the predictive ability of these biomarkers with new-onset postpartum preeclampsia. High-risk participants will be randomized to a bundle of care strategies aimed at early detection and management of postpartum preeclampsia.
• Pregnant patients ≥ 36 weeks gestation without major fetal anomalies
• Age ≥ 18 years
• Admitted for labor at Dhulikhel Hospital, or intend to deliver at Dhulikhel Hospital
• At risk for preeclampsia, using the Clinical Risk Assessment for Preeclampsia according to ACOG and USPSTF
‣ 1 or more high risk factors:
• History of preeclampsia
∙ Type 1 or 2 diabetes
∙ Multifetal gestation?
∙ Renal disease
∙ Autoimmune disease
⁃ 2 or more moderate risk factors:
• Nulliparity
∙ BMI \> 30
∙ First-degree relative with a history of preeclampsia
∙ African American race
∙ Low socioeconomic status
∙ Age \> 35 years
∙ History of low birthweight or small for gestational age
∙ Previous adverse pregnancy outcome
∙ Interpregnancy interval \> 10 years