title: Association between placental growth factor levels in early onset preeclampsia with the occurrence of postpartum hemorrhage: A prospective cohort study.
abstract: OBJECTIVE
  To determine the association between PlGF (placental growth factor) estimation in early second trimester (22-24weeks of gestation), with the occurrence of postpartum hemorrhage in pregnant women with early onset preeclampsia and whether the mode of delivery (cesarean or vaginal) has any association with increased risk of developing postpartum hemorrhage.
  
  
  METHODS
  A prospective cohort study was conducted on 788 pregnant women with singleton pregnancies diagnosed with early onset preeclampsia between March 2009 and June 2011. Maternal serum PlGF level estimation was done between 22 and 24weeks of gestation and a cut-off value of <122pg/ml was determined by receiver operating characteristic (ROC) curve analysis for identifying those at risk of developing postpartum hemorrhage. Association between serum PlGF level <122pg/ml and cesarean deliveries with the risk of developing postpartum hemorrhage was analyzed by logistic regression analysis and Odds ratio, which were computed. The results were considered statistically significant when P-value <0.05.
  
  
  METHODS
  Proportion of study population developing postpartum hemorrhage.
  
  
  RESULTS
  Logistic regression analysis showed the association of serum PlGF <122pg/ml at 22-24weeks (Odds ratio 8.9516; 95% CI, 5.0728-15.7963) and that of cesarean delivery (Odds ratio 2.4252; 95% CI, 1.4573-4.0360) with the risk of developing postpartum hemorrhage. Both the associations were found to be statistically significant.
  
  
  CONCLUSIONS
  Maternal serum PlGF level <122pg/ml at 22-24weeks of gestation and cesarean delivery are both strongly associated with the risk of developing postpartum hemorrhage in pregnant women with early onset preeclampsia.
authors.affiliation: Department of Anatomy, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, Shaheed Bhagat Singh Marg, New Delhi 110 001, India. Electronic address: drsanjib79@gmail.com.
authors.forename: Sanjib Kumar
authors.initials: SK
authors.lastname: Ghosh
authors.affiliation: Department of Anatomy, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, Shaheed Bhagat Singh Marg, New Delhi 110 001, India. Electronic address: shashianat28@yahoo.com.
authors.forename: Shashi
authors.initials: S
authors.lastname: Raheja
authors.affiliation: Department of Anatomy, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, Shaheed Bhagat Singh Marg, New Delhi 110 001, India. Electronic address: tulianitalhmc14@rediffmail.com.
authors.forename: Anita
authors.initials: A
authors.lastname: Tuli
authors.affiliation: Department of Obstetrics & Gynecology, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, Shaheed Bhagat Singh Marg, New Delhi 110 001, India. Electronic address: chitralhmc22@gmail.com.
authors.forename: Chitra
authors.initials: C
authors.lastname: Raghunandan
authors.affiliation: Department of Anatomy, Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, Shaheed Bhagat Singh Marg, New Delhi 110 001, India. Electronic address: yashwantsneh63@yahoo.com.
authors.forename: Sneh
authors.initials: S
authors.lastname: Agarwal
keywords: Cesarean section; Logistic regression analysis; Placental growth factor; Postpartum hemorrhage; Preeclampsia; Receiver operating characteristic curve