Comparison of placental growth factor and fetal flow Doppler ultrasonography to identify fetal adverse outcomes in women with hypertensive disorders of pregnancy: an observational study

Abstract

BackgroundHypertensive disorders of pregnancy and intrauterine growth restriction (IUGR) are leading causes of maternal and perinatal morbidity and mortality. Failure to detect intrauterine growth restriction in women at high risk has been highlighted as a significant avoidable cause of serious fetal outcome. In this observational study we compare fetal flow using Doppler ultrasonography with a new test for placental growth factor (PlGF) to predict fetal adverse events.MethodsEighty-nine women with hypertensive disorders of pregnancy (24 with chronic hypertension, 17 with gestational hypertension, 12 with HELLP syndrome, 19 with preeclampsia and 17 with superimposed preeclampsia) were enrolled. A single maternal blood sample to measure free PlGF (Alere Triage) taken before 35 weeks of pregnancy was compared to the last Doppler ultrasound measurement of fetal flow before delivery. PlGF was classified as normal (PlGF≥100 pg/ml), low (12<PlGF<100) or very low (PlGF≤12 pg/ml). A positive test for abnormal fetal flow was defined as either signs of centralisation of the fetal circulation or diastolic block or reverse flow in the umbilical artery or descending aorta; this was a criterion for delivery. Fetal outcomes were intrauterine growth restriction and birth before 37 weeks of pregnancy.ResultsIn total 61/89 women had a preterm birth and 22 infants had IUGR. Of those who delivered preterm, 20/20 women with abnormal fetal flow and 36/41 (87.8%) women with normal fetal flow had low or very low PlGF. Of those infants with IUGR, 22/22 had low or very low maternal PlGF and 10/22 had abnormal fetal flow.ConclusionsPlGF may provide useful information before 35th gestational week to identify fetuses requiring urgent delivery, and those at risk of later adverse outcomes not identified by fetal flow Doppler ultrasonography.

Placental growth factor concentration in maternal circulation decreases after fetal death: lessons from a case series study

“…Furthermore, it could be argued that the collapse of fetal circulation on its own is a primary reason for a reduction in PlGF levels. Although we cannot exclude this possibility, previous studies have found an inverse correlation between PlGF and fetal well-being in pregnancies in which fetal circulation was preserved [36]. Finally, in light of the sensitive situation of the women participating in this study, we recruited the minimal number of women that still allows valid statistical analysis.…”

Placental Growth Factor Influences Maternal Cardiovascular Adaptation to Pregnancy in Mice1

“…In humans, maternal plasma PGF deficiency is linked to the hypertensive disorder preeclampsia and fetal growth restriction [21][22][23]. However, neither the effects of PGF on regulation of maternal blood pressure nor the roles of PGF in fetal development and growth are known.…”

The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study

“…One major challenge is the increased risk of preeclampsia, eclampsia [6, 7], and related conditions, such as preterm delivery [5, 6] and intrauterine growth restriction [6, 8], that increase morbidity and mortality in the mother [2] and foetus [4, 9]. …”