Prediction of severe maternal and perinatal complications in hypertensive pregnancies using point-of-care glycosylated fibronectin: A prospective cohort study

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OBJECTIVES: To evaluate the test accuracy of glycosylated fibronectin (GlyFn) to predict adverse maternal and neonatal outcomes in women with hypertensive pregnancies in a low resourced setting. STUDY DESIGN: Prospective observational study at a Tertiary government hospital in Freetown, Sierra Leone. Hypertensive women between 24 - 36 + 6 weeks' gestation were recruited and Point-of-care GlyFn test was performed at time of recruitment. MAIN OUTCOME MEASURES: Diagnostic accuracy measures for adverse maternal (maternal death and eclampsia) and neonatal (stillbirth, neonatal death and termination pre-viability) outcomes including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for predefined GlyFn thresholds using STATA. RESULTS: Complete outcome data was available for 172 women. 11.6% (20/172) of women had a composite maternal outcome with 16 cases of eclampsia and eight maternal deaths. For the composite maternal outcome and stillbirth, GlyFn had a 100% sensitivity and NPV when taken before 34 weeks' gestation. GlyFn also showed good time to delivery prediction when taken before 34 week gestation (AUROC: 0.69, [0.56 - 0.81]) and good predictive performance for placental abruption (AUROC: 0.82, [0.75-0.88]) and small-for-gestational-age babies (below the 3rd centile) (AUROC: 0.71, [0.54-0.87]). CONCLUSIONS: In low-resource settings, GlyFn could serve as a risk-stratification tool for severe maternal and neonatal complications in women presenting with hypertension in low-resource settings.

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