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Role of sFlt-1/PlGF ratio and feto-maternal Doppler for the prediction of adverse perinatal outcome in late-onset pre-eclampsia.
Graupner, Oliver; Karge, Anne; Flechsenhar, Sarah; Seiler, Alina; Haller, Bernhard; Ortiz, Javier U; Lobmaier, Silvia M; Axt-Fliedner, Roland; Enzensberger, Christian; Abel, Kathrin; Kuschel, Bettina.
Afiliação
  • Graupner O; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. Oliver.Graupner@mri.tum.de.
  • Karge A; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
  • Flechsenhar S; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
  • Seiler A; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
  • Haller B; Institute for Medical Informatics, Statistics and Epidemiology (IMedIS), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.
  • Ortiz JU; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
  • Lobmaier SM; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
  • Axt-Fliedner R; Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany.
  • Enzensberger C; Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany.
  • Abel K; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
  • Kuschel B; Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
Arch Gynecol Obstet ; 301(2): 375-385, 2020 02.
Article em En | MEDLINE | ID: mdl-31734756
ABSTRACT

PURPOSE:

The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio and uterine artery Doppler have shown to be helpful in the diagnosis of pre-eclampsia (PE). The predictive value of the cerebroplacental ratio (CPR) regarding adverse perinatal outcome (APO) in low-risk pregnancies is intensively discussed. We evaluated the extent to which sFlt-1/PlGF ratio and feto-maternal Doppler may be useful in predicting APO in singleton pregnancies complicated by late-onset PE and/or HELLP syndrome.

METHODS:

This is a retrospective study from 2010 to 2018 consisting of singleton pregnancies with confirmed diagnosis of late-onset (lo ≥ 34 weeks) PE/HELLP syndrome in which sFlt-1/PlGF ratio and feto-maternal Doppler (mUtA-PI mean uterine artery pulsatility index and CPR) were determined. The ability of sFlt-1/PlGF ratio, mUtA-PI, CPR and their combination to predict APO or SGA was evaluated using receiver operating characteristic (ROC) curves.

RESULTS:

67 patients were included in the final analysis. Of these, sFlt-1/PlGF was > 110 (defining angiogenic lo PE) in 40.3% (27/67), mUtA-PI was above the 95th centile in 34.3% (23/67) patients and CPR was lower than the 5th centile in 10.4% (7/67). Abnormal sFlt-1/PlGF and mUtA-PI as well as CPR were associated with a lower birth weight (BW). Late-preterm birth (< 37 weeks) as well as postnatal diagnosis of small for gestational age (SGA BW < 3rd centile) was significantly more often in angiogenic lo PE cases. Neither sFlt-1/PIGF nor CPR or mUtA-PI were APO predictors. Only for sFlt-1/PlGF, ROC analysis revealed a significant predictive value for postnatal SGA (AUC = 0.856, p = 0.001, 95% CI 0.75-0.97). There was no statistical added value of combined SGA predictors as compared to sFlt-1/PlGF alone.

CONCLUSIONS:

In patients with lo PE, adding sFlt-1/PlGF ratio to routine antepartum fetal surveillance may be useful to identify cases of postnatal SGA. However, further prospective studies are warranted to define the role of feto-maternal Doppler and sFlt-1/PlGF ratio as outcome predictors.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pré-Eclâmpsia / Proteínas da Gravidez / Recém-Nascido Pequeno para a Idade Gestacional / Ultrassonografia Doppler / Receptor 1 de Fatores de Crescimento do Endotélio Vascular / Artéria Uterina / Fator de Crescimento Placentário Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Newborn / Pregnancy Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Pré-Eclâmpsia / Proteínas da Gravidez / Recém-Nascido Pequeno para a Idade Gestacional / Ultrassonografia Doppler / Receptor 1 de Fatores de Crescimento do Endotélio Vascular / Artéria Uterina / Fator de Crescimento Placentário Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Newborn / Pregnancy Idioma: En Ano de publicação: 2020 Tipo de documento: Article