OP14.03: Circulatory soluble endoglin and its predictive value for preeclampsia in second trimester pregnancies with abnormal uterine perfusion

Abstract

Objectives: Soluble endoglin (sEng) is dramatically increased in preeclampsia (PE) and acts synergistically with sFlt1 to promote the pre-eclamptic phenotype. The aim of this study was to investigate, whether the sEng increase is already present in second-trimester pregnancies with abnormal perfusion and therefore at risk for PE. Methods: This prospective study included 77 second-trimester pregnant women with abnormal uterine perfusion. sEng and sFlt1 were measured using an ELISA. Results: Adverse pregnancy outcome was associated with higher sEng levels in the second trimester. sEng was highest in those with early-onset PE. Combined analysis of sEng and sFlt1 is able to predict early-onset PE with a sensitivity of 100% and specificity of 93.3%. Conclusions: Elevated sEng levels are detectable in second-trimester pregnancies with abnormal uterine perfusion and subsequent pregnancy complications. The concurrent measurement of uterine perfusion and angiogenic factors allows a highly efficient prediction of early-onset PE. Objectives: Women with abnormal first-and second-trimester serum screening markers are at increased risk of adverse pregnancy outcome. We prospectively evaluated second-trimester uterine artery Doppler in these women. Methods: Women booked at University College London Hospital, who had combined, quadruple or integrated test screening for Down syndrome were offered uterine artery Doppler examination if they had one or more of the following serum screening results: PAPP-A < 0.28MoM (1% of screened population), inhibin > 3.0MoM (2%), hCG > 4.0MoM (2%), AFP > 2.5MoM (2%) and estriol < 0.5MoM (1%). Maternal casenotes were examined for adverse pregnancy outcomes (Table). Abnormal uterine artery Doppler was defined as bilateral or unilateral notching or mean pulsatility index > 1.6. All scan reports and pregnancy outcome data were analyzed statistically. Results: There were 98 women who fulfilled the serum screening criteria and had pregnancy outcome data; none had a fetus with aneuploidy. Of these, 38 women had one or more adverse pregnancy outcomes (39% , Table). OP14.04 Adverse pregnancy outcome Number of patients with outcomeLate miscarriage or stillbirth 7 Preterm delivery 7 Preterm premature rupture of the membranes 6 Pre-eclampsia 5 Gestational hypertension 6 Abruption or recurrent antepartum hemorrhage 4 Fetal growth restriction (< 5th customized centile) 17Uterine artery Doppler was performed in 88 women and was abnormal in 18 (20%). Women with adverse pregnancy outcome were significantly more likely to have abnormal uterine artery Doppler (10 of 18) compared with women with normal outcome (18 out of 70, Chi-squared test, P < 0.01). Conclusions: Abnormal uterine artery Doppler examination is significantly more common in women with abnormal first-and second-trimester serum screening markers who subsequently develop an adverse pregnancy outcome. However a normal uterine artery Doppler examination in these women does not rule out an adverse pregnancy outcome, and these women should be offered regul...