Pre‐eclampsia (PE) is characterized by placental and maternal endothelial dysfunction, and associated with fetal growth restriction (FGR), placental abruption, preterm delivery and stillbirth. The angiogenic factors soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and placental growth factor (PlGF) are altered in pregnancies complicated by placenta‐related disorders. In this Review, we summarize the existing knowledge, examining the performance of maternal PlGF, sFlt‐1 and the sFlt‐1/PlGF ratio for screening PE, predicting development of PE in the short term, diagnosing PE, monitoring established PE and predicting other placenta‐related disorders in singleton pregnancy. We also discuss the performance of PlGF and the sFlt‐1/PlGF ratio for predicting PE in twin pregnancy. For first‐trimester screening in singleton pregnancy, a more accurate way of identifying high‐risk women than current practice is to combine maternal PlGF levels with clinical risk factors and ultrasound markers. Later in pregnancy, the sFlt‐1/PlGF ratio has advantages over PlGF because it has a higher pooled sensitivity and specificity for diagnosing and monitoring PE. It has clinical value because it can rule out the development of PE in the 1–4‐week period after the test. Once a diagnosis of PE is established, repeat measurement of sFlt‐1 and PlGF can help monitor progression of the condition and may inform clinical decision‐making regarding the optimal time for delivery. The sFlt‐1/PlGF ratio is useful for predicting FGR and preterm delivery, but the association between stillbirth and the angiogenic factors is unclear. The sFlt‐1/PlGF ratio can be used to predict PE in twin pregnancy, although different sFlt‐1/PlGF ratio cut‐offs from those for singleton pregnancy should be applied for optimal performance. In summary, PlGF, sFlt‐1 and the sFlt‐1/PlGF ratio are useful for screening, diagnosing, predicting and monitoring placenta‐related disorders in singleton and twin pregnancy. We propose that tests for these angiogenic factors are integrated more fully into clinical practice.© 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Several investigators have hypothesized that outpatient preinduction cervical ripening with nitric oxide donors such as isosorbide mononitrate (IMN) would reduce the elapsed time from hospital admission to delivery and improve women's experience of induction of labor. This double-blind randomized placebo-controlled trial investigated whether vaginal self-administration at home by woman at term would improve the process of induction of labor. The study subjects were 350 nulliparous singleton women with cephalic presentation at Ն37 weeks' gestation, requiring cervical ripening before induction of labor. The participants self-administered IMN (n ϭ 177) or placebo (n ϭ 173) vaginally at home without fetal monitoring at 48, 32, and 16 hours before the scheduled time of admission for induction of labor. The primary study outcome measures were the elapsed time interval from hospital admission to delivery and the women's experience of home treatment for cervical ripening. Maternal satisfaction was determined with a questionnaire, using a 10 point scale with 1 ϭ extremely good and 10 ϭ not at all good.There was no statistically significant difference between the 2 study groups in the admission to delivery interval; the mean difference was 1.59 hours, with a 95% confidence interval (CI) of Ϫ5.08 to 1.89, P ϭ 0.37. Compared to placebo, however, IMN was more effective in inducing a mean change in modified Bishop score from recruitment to hospital admission (mean difference: 0.65 [95% CI, 0.14-1.17, P ϭ 0.013]). With regard to maternal satisfaction, the overall experience of home treatment was positive in both groups. Women in the placebo group reported it to be marginally more positive than those in the IMN group (placebo: 3.23 vs. IMN: 3.84; the mean difference was 0.61, with a 95% CI of 0.02-1.21, P ϭ 0.043). No difference between the 2 groups was reported in either pain or anxiety levels or in the willingness to have the treatment in a subsequent pregnancy.These data show that administration of IMN at home is effective in ripening the cervix but does not shorten the admission to delivery interval or improve maternal satisfaction. The investigators conclude from these findings that IMN in this setting has limited clinical value. EDITORIAL COMMENT(The appeal of the nitric oxide donor isosorbide mononitate (IMN) is its potential to induce cervical ripening without precipitating uterine contractions and thereby obviate the need for fetal heart rate monitoring, and allow cervical ripening to be conducted on an outpatient ba-OBSTETRICS Volume 64, Number 11 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT This investigation was conducted as part of the Mother-Infant Rapid Intervention at Delivery (MIRIAD) study, a prospective, multicenter trial assessing routine rapid human immunodeficiency virus (HIV) screening of pregnant women in inpatient and outpatient settings. This study compared rapid HIV testing with conventional HIV testing in outpatient obstetric settings among a population of pregnant women who presented late in care wi...

No abstract