The sFlt-1 (soluble fms-like tyrosine kinase-1) / PlGF (placental growth factor) ratio and uterine artery Doppler are useful tools in the diagnosis of pre-eclampsia (PE). There is debate about the cerebroplacental ratio (CPR) regarding adverse perinatal outcome (APO) prediction in low-risk pregnancies. 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: 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 was evaluated using receiver operating characteristic (ROC) curves. Results: 67 patients were included for final analysis. Of these, sFlt-1/PlGF was > 110 (defining angiogenic lo PE) in 40.3% (27/67). Abnormal sFlt-1/PlGF and mUtA-PI (> 95 th centile) as well as CPR (< 5 th centile) were associated with lower birth weight. Late-preterm birth (< 37 weeks) as well as postnatal diagnosis of small for gestational age (SGA) was significantly more often in angiogenic lo PE cases. Only for sFlt-1/PlGF, ROC analysis revealed significant association with APO (AUC = 0.684, p = 0.011, 95%-CI: 0.55-0.82). There was no statistical added value of combined APO predictors as compared to sFlt-1/P1GF alone. Conclusions: In patients with lo PE, adding sFlt-1/PlGF ratio to routine antepartum fetal surveillance may be useful for the prediction of APO especially to identify cases of postnatal SGA. However, for planning of delivery in lo PE itself, further prospective studies are necessary to define the role of feto-maternal Doppler and sFlt-1/PlGF ratio as outcome predictors.
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