Prediction of preeclampsia and induced delivery at <34 weeks gestation by sFLT-1 and PlGF in patients with abnormal midtrimester uterine Doppler velocimetry: a prospective cohort analysis

Abstract

BackgroundWomen with bilateral abnormal uterine artery Doppler velocimetry (UtADV) are at increased risk for an adverse pregnancy outcome. This study aimed to determine if additional assessment of midtrimester angiogenic factors improves the predictive accuracy of Doppler results for various outcome parameters.MethodsWomen with a bilateral abnormal UtADV, which was defined as a postsystolic incision and/or an increased pulsatility index greater than the 95th centile, and a singleton pregnancy were prospectively recruited between 19 + 0 and 26 + 6 weeks of gestation. Maternal serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT-1) were measured with a fully automated immunoassay and their ratio was calculated.ResultsAngiogenic factors could predict the development of preeclampsia (PE), as well as induced delivery at <34 weeks of gestation, but failed to predict the development of normotensive intrauterine growth restriction. Twelve (24.0%) of the 50 recruited women developed PE. Nine of these patients had early-onset disease (<34 + 0 weeks). Six (12.0%) patients were delivered at <34 + 0 weeks. The most useful test results in the prediction of PE and induced delivery at <34 + 0 weeks were observed using the sFLT-1/PlGF >95th centile ratio with a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 66.7%, 89.5%, 66.7%, and 89.5% for PE, and 85.7%, 86.1%, 50.1%, and 97.4% for induced delivery, respectively. Positive and negative likelihood ratios were 6.33 (95% CI 2.31–17.38) and 0.37 (95% CI 0.17–0.84) for PE, and 6.14 (95% CI 2.76–13.69) and 0.17 (0.03–1.02) for induced delivery, respectively. Corresponding odds ratios were 17.0 (95% CI 3.5–83.0) and 37.0 (95% CI 3.8–363.9), respectively.ConclusionsMeasurement of angiogenic factors improves the specificity of an abnormal UtADV for prediction of PE. Compared with prediction of PE an abnormal sFLT-1/PlGF ratio revealed higher sensitivity for prediction of induced delivery at <34 + 0 weeks. The NPV of 97% will help to reassure most patients with an abnormal UtADV and a normal sFLT-1/PlGF ratio.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-292) contains supplementary material, which is available to authorized users.

The expression of the imprinted gene pleckstrin homology‐like domain family A member 2 in placental tissues of preeclampsia and its effects on the proliferation, migration and invasion of trophoblast cells JEG‐3

“…There were no differences between the two groups in terms of age. Moreover, PE patients had significantly higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) when compared with controls and all patients displayed proteinuria, which is consistent with previous reports …”

Implementation of the sFlt‐1/PlGF ratio for prediction and diagnosis of pre‐eclampsia in singleton pregnancy: implications for clinical practice

“…Combining the sFlt‐1/PlGF ratio with UtA Doppler ultrasound, at the time of diagnosis of early‐onset PE, has prognostic value mainly for perinatal complications, being limited for the prediction of maternal complications. The additional measurement of the sFlt‐1/PlGF ratio has been shown to improve the sensitivity and specificity of Doppler measurement in predicting PE, supporting its implementation in screening algorithms.…”

Levels of serum‐circulating angiogenic factors within 1 week prior to delivery are closely related to conditions of pregnant women with pre‐eclampsia, gestational hypertension, and/or fetal growth restriction

“…These markers seem to change several weeks before the onset of PE. The imbalance of these circulating angiogenic factors is thought to cause vascular endothelial dysfunction, resulting in the maternal symptoms of PE . To more sensitively reflect this pathogenesis, use of the ratio of sFlt‐1 to PlGF (sFlt‐1/PlGF) has recently been introduced.…”