PREP-S: Risk of complications in Early-onset Pre-eclampsia
The PREP-S model is an externally validated survival regression based prognostic model predicting the risk of complications in early-onset pre-eclampsia at various timepoints following diagnosis until 34 weeks of pregnancy. It was developed together with the PREP-L model, which is a logistic regression model and allows risk prediction by the time of discharge. 

An evaluation of the impact of the PREP models in clinical practice is still required. 

PREP models can be used to obtain predictions of adverse maternal outcome risk, including early preterm delivery, by 48 hours (PREP-S) and by discharge (PREP-L), in women with early onset pre-eclampsia in the context of current care.

Note: The PREP-L and PREP-S models can be calculated together in the composite model. 

 
Research authors: Shakila Thangaratinam, John Allotey, Nadine Marlin, Julie Dodds, Fiona Cheong-See, Peter von Dadelszen, Wessel Ganzevoort, Joost Akkermans, Sally Kerry, Ben W. Mol, Karl G.M. Moons, Richard D. Riley, Khalid S. Khan
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Predicted risk of adverse event by the timepoint indicated is: %

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The PREP-S model is best to be used together with the PREP-L model. With good agreement between the predicted and observed risk of complications in the PREP-S at 48 hours in the low- and intermediate-risk groups, women with a predicted probability of complications below 50% can avoid unnecessary transfer to tertiary units. Women categorised to be low risk by the PREP-L model could be followed-up in an outpatient setting, with high- and very high-risk women monitored as inpatients with regular intensive monitoring.

Provision of personalised risk information allows parents to have the opportunity to discuss the expected outcomes. It is important to recognise that all prediction models in this field, including the PREP models, provides risk estimates in the context of current care and clinical management decisions. The models are not designed to guide clinicians’ decisions on choice of management such as timing of delivery, administration of anti-hypertensives and magnesium sulfate. A woman with a low predicted risk should be viewed as an individual with low outcome risk if current care pathways are used, as it may be the clinical care that results in her low-risk status.

An important note is that the PREP models need proper evaluation of their impact in clinical practice. Thresholds for interventions (such as transfer to tertiary care units, or hospital admission) need to be established. 

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