A multicenter randomized trial of screening with sFlt1/ PlGF and planned delivery to prevent preeclampsia at term.

Preeclampsia (PE) remains a leading cause of maternal morbidity and mortality in the world. Prediction and prevention of term PE remains unsolved. Recent evidence showsthatsFlt1-PlGF ratio at 35-37 weeks predicts term PE with 80% detection rate. Likewise, recent studies demonstrate that induction of labor from 37 weeks is safe. • The investigators hypothesize that a single-step universal screening for term PE based on sFlt1/PlGF ratio at 35.0-36.6 weeks followed by planned delivery (e.g. induction of labor) from 37.0 weeks would reduce the prevalence of term PE, without increasing cesarean section rates or adverse neonatal outcomes. The investigators propose a randomized clinical trial to evaluate the impact of a screening of term PE with sFlt-1/PlGF ratio in asymptomatic nulliparous women at 35.0-36.6 weeks. Women will be assigned to revealed (sFlt-1/PlGF known to clinicians and participants) versus concealed (unknown to clinicians and participants) arms. A cutoff of >90th centile will be used to define high risk of term PE and planned delivery will be offered from 37.0 weeks. If successful, the results of this trial will provide evidence to support a simple universal screening strategy to reduce the prevalence of term PE, which could be applicable in most healthcare settings and have enormous implications on perinatal outcomes and public health policies worldwide.