An intermediate sFlt-1/PlGF ratio indicates an increased risk for adverse pregnancy outcome.

OBJECTIVE: The sFlt-1/PlGF ratio is a valid marker in diagnosing or excluding preeclampsia. The currently used cut offs frame an intermediate zone of 33-85 (<340 weeks) or 33-110 (≥340 weeks), respectively. In this study we sought to evaluate the relevance of an intermediate sFlt-1/PlGF ratio for the clinical pregnancy course and outcome. MATERIAL AND METHODS: We retrospectively analysed 533 consecutive patients with sFlt-1/PlGF ratio measurements for suspected preeclampsia. In patients with an intermediate sFlt-1/PlGF ratio, fetal and maternal characteristics and also pregnancy outcome were documented. Furthermore, we compared the patient groups with <340/340-366/≥370 gestational weeks at first visit. RESULTS: 83/533 (15.6%) patients had an intermediate sFlt-1/PlGF ratio. Maternal or fetal diseases or twin pregnancies occurred in 87.9%. Preeclampsia/HELLP syndrome developed in 31.3% but were mostly mild or moderate (65.4%). However, severe adverse outcome was observed in 36.1% with severe preeclampsia in 10.8%. Even if further pregnancy duration and gestational week correlated negatively (r=-0.424; p<0.001), 92% of patients, tested with <340 weeks delivered prematurely. The overall preterm birth rate was 27.7%. CONCLUSIONS: Patients with an intermediate sFlt-1/PlGF ratio are at risk for severe adverse outcome. An intermediate sFlt-1/PlGF ratio indicates a risk for preterm birth, independent from the occurrence of preeclampsia.

The impact of uterine curettage postpartum on maternal sFlt-1 concentration.

Our purpose was to investigate the influence of a uterine curettage on the immediate maternal sFlt-1 concentration post partum. Forty-six patients booked for delivery via primary caesarean section were included in a prospective open, case control study. Eighteen of them achieved an intraoperative curettage and formed the treatment group, 28 patients without curettage were enrolled in the control group. Maternal sFlt-1 serum values were measured immediately before and 24 h after delivery. Patients who underwent a uterine curettage showed a relative decrease of 70% (median 3670±1110 pg/mL-1143±270 pg/mL) in comparison to the control group with 65% (median 3132±636 pg/mL-1098±611 pg/mL; P=0.558). Additionally, three patients with preeclampsia and curettage were included, who showed a relative decrease of 76%. A uterine curettage may slightly accelerate the fall of the postpartal sFlt-1 concentration. The previously described benefit of curettage in patients with preeclampsia regarding faster recovery or treatment of postpartum seizures may be partly explained as mediated by anti-angiogenic factors.