sFlt-1/PlGF for prediction of early-onset pre-eclampsia: STEPS (Study of Early Pre-eclampsia in Spain).

OBJECTIVE: A high ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) has been linked to pre-eclampsia (PE). We evaluated the sFlt-1/PlGF ratio as a predictive marker for early-onset PE in women at risk of PE. METHODS: This prospective, Spanish, multicenter study included pregnant women with a risk factor for PE, including intrauterine growth restriction, PE, eclampsia or hemolysis, elevated liver enzymes and low platelet count syndrome in previous pregnancy, pregestational diabetes or abnormal uterine artery Doppler. The primary objective was to show that the sFlt-1/PlGF ratio at 20, 24 and 28 weeks' gestation was predictive of early-onset PE (< 34 + 0 weeks). Serum sFlt-1 and PlGF were measured at 20, 24 and 28 weeks. Multivariate logistic regression was used to develop a predictive model. RESULTS: A total of 819 women were enrolled, of which 729 were suitable for analysis. Of these, 78 (10.7%) women developed PE (24 early onset and 54 late onset). Median sFlt-1/PlGF ratio at 20, 24 and 28 weeks was 6.3 (interquartile range (IQR), 4.1-9.3), 4.0 (IQR, 2.6-6.3) and 3.3 (IQR, 2.0-5.9), respectively, for women who did not develop PE (controls); 14.5 (IQR, 5.5-43.7), 18.4 (IQR, 8.2-57.9) and 51.9 (IQR, 11.5-145.6) for women with early-onset PE; and 6.7 (IQR, 4.6-9.9), 4.7 (IQR, 2.8-7.2) and 6.0 (IQR, 3.8-10.5) for women with late-onset PE. Compared with early-onset PE, the sFlt-1/PlGF ratio was significantly lower in controls (P < 0.001 at each timepoint) and in women with chronic hypertension (P < 0.001 at each timepoint), gestational hypertension (P < 0.001 at each timepoint) and late-onset PE (P < 0.001 at each timepoint). A prediction model for early-onset PE was developed, which included the sFlt-1/PlGF ratio plus mean arterial pressure, being parous and previous PE, with areas under the receiver-operating characteristics curves of 0.86 (95% CI, 0.77-0.95), 0.91 (95% CI, 0.85-0.97) and 0.93 (95% CI, 0.86-0.99) at 20, 24 and 28 weeks, respectively, and was superior to models using the sFlt-1/PlGF ratio alone or uterine artery mean pulsatility index. CONCLUSIONS: The sFlt-1/PlGF ratio can improve prediction of early-onset PE for women at risk of this condition. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Impacto de la edad materna avanzada en las complicaciones obstétricas y perinatales de las gestaciones gemelares / Impact of advanced maternal age on obstetric and perinatal complications in twin pregnancies

Objetivo: La finalidad de este estudio es evaluar los resultados obstétricos y perinatales de las gestaciones gemelares en mujeres con edad mayor o igual a 35 años. Material y métodos Se diseñó un estudio de cohortes retrospectivo. Las complicaciones obstétricas, el tipo de parto y los resultados perinatales de 229 gestantes con edad igual o superior a 35 años en la fecha de parto se compararon con 374 gestantes con edad inferior a 35 años. El estudio se realizó a través de la base de datos informatizada y la revisión de las historias clínicas de las pacientes atendidas en el Hospital Universitario Miguel Servet (HUMS) desde enero de 2001 hasta diciembre de 2007.ResultadosSe evidencia que la edad materna avanzada se asocia a un incremento del riesgo de embarazo tras técnicas de reproducción asistida, (p>0,001), gestación bicorial (p>0,001) y diabetes gestacional (p=0,007; IC 95% 1,119-3,19). No se ha encontrado asociación significativa entre la edad materna avanzada y una mayor incidencia de parto prematuro, rotura prematura de membranas, retraso de crecimiento intrauterino, cesárea y mortalidad perinatal. Conclusión Basándonos en nuestros datos y los reflejados por estudios previos podemos decir que la edad materna avanzada en las gestaciones gemelares no parece incrementar de forma significativa las complicaciones obstétricas ni los resultados perinatales adversos (AU)

Objective: To evaluate the pregnancy and perinatal outcomes of twin gestations in women aged35 or older. Material and methods: We designed a retrospective cohort study. Maternal complications, mode of delivery and perinatal outcomes were compared in 229 women who delivered at age 35or older and in 374 women who delivered at age less than 35 years. The computerized database and medical records of pregnant women attending the Miguel Servet University Hospital from January 2001 to December 2007 were retrospectively reviewed. Results: Older women had an increased risk of conceptions after assisted reproductive techniques (p > 0.001), dichorionic pregnancies (p > 0.001) and gestational diabetes (p = 0.007; 95%CI: 1.119-3.19). There was no significant association between older maternal age and an increased incidence of preterm labor, premature rupture of membranes, fetal growth restriction, cesarean delivery or perinatal mortality. Conclusion: Based on our data and previous studies, advanced maternal age in twin pregnancies does not seem to significantly increase obstetric complications or adverse perinatal results (AU)

Análisis de la finalización de la gestación y morbilidad materna en las gestaciones de 41 semanas / Analysis of delivery mode and maternal morbidity in pregnancies ending at 41 weeks

Objetivo El propósito de este estudio es evaluar el tipo de parto y la morbilidad materna asociados a las gestaciones que finalizan en la semana 41. Material y métodos Se ha diseñado un estudio de cohortes históricas. El tipo de parto y las complicaciones maternas de 230 gestaciones de 41 semanas se compararon con 234 gestaciones que finalizaron entre las 37 y las 40 semanas de gestación en el Hospital Universitario Miguel Servet en 2005. Resultados Se evidencia que las mujeres que finalizan la gestación en la semana 41 tienen un mayor riesgo de despegamiento de membranas, Bishop desfavorable al ingreso, inducción y mayor duración del parto. También se pone de manifiesto un incremento de las tasas de parto instrumentado (25,6 vs 17,6%, p<0,001) y de cesárea (21,70 vs 8,50%, p<0,001). Conclusiones La tasa de complicaciones maternas periparto se incrementa cuando se alcanza la semana 41 de gestación. La apropiada investigación de este hecho es importante en la determinación de la edad gestacional a la cual el riesgo de continuar el embarazo supera el riesgo de una inducción de parto (AU)

Objective To evaluate the mode of delivery and maternal morbidity associated with pregnancies ending at 41 weeks. Material and methods We designed a retrospective cohort study. The mode of delivery and maternal complications of 230 pregnancies ending at 41 weeks were compared with those in 234 pregnancies ending between 37 and 40 weeks at the Miguel Servet University Hospital in 2005. Results Women delivering at 41 weeks had an increased risk of membrane sweep, un favorable Bishop score at admission, induction and longer duration of labor. These increases were also seen in the rates of operative vaginal delivery (25.6 vs 17.6%, p<0.001) and cesarean section (21.7 vs 8.5%, p<0.001). Conclusions The rates of maternal peripartum complications increase as pregnancy reaches 41 weeks. Accurate investigation of these rates is important to determine the gestational age at which the risk of continuing the pregnancy outweighs the risk of labor induction (AU)

Successful methotrexate treatment of an abdominal pregnancy in the pouch of Douglas.

Abdominal pregnancy is a rare localization of ectopic pregnancy. Early diagnosis and treatment are advised and the choice of treatment is crucial. A successful case of conservative treatment with combined systemic and intra-amniotic methotrexate is presented. This treatment option should be considered in the management of this potentially life-threatening condition.