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

doi:10.1007/s00404-019-05365-9

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2020

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Title:: Role of sFlt-1/PlGF ratio and feto-maternal Doppler for the prediction of adverse perinatal outcome in late-onset pre-eclampsia.
Document type:: Journal Article
Author(s):: 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
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.
Journal title abbreviation:: Arch Gynecol Obstet
Year:: 2020
Journal volume:: 301
Journal issue:: 2
Pages contribution:: 375-385
Fulltext / DOI:: doi:10.1007/s00404-019-05365-9
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31734756
Print-ISSN:: 0932-0067
TUM Institution:: Frauenklinik und Poliklinik; Institut für Medizinische Statistik und Epidemiologie
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