Predictive value of vascular endothelial growth factor and placenta growth factor for morbidly adherent placenta among women with previous history of cesarean section

Abstract

Background The present study aims to determine the predictive value of vascular endothelial growth factor (VEGF) and placenta growth factor (PLGF) for placenta accreta and for the comparison of the serum level of VEGF and PLGF in normal pregnant women and women with placenta accreta spectrum (PAS).Methods This prospective case-control study was conducted during the 2 years in two hospital in Shiraz, Iran from 2017 to 2019. The inclusion of the study was 90 singleton pregnant women: 45 of them in gestational ages of 28-34 weeks with pathological confirmation of placenta accreta spectrum and 45 healthy pregnant women. In the PAS group, according to pathology reports on the placenta, we divided all cases to placenta accreta, percreta, and increta. Maternal serum level of VEGF and PLGF were measured before the termination of pregnancy and diagnostic accuracy of each factor was evaluated.Results In PAS group, 75 percent of patients had placenta previa and unlike the control group, there was a significant difference in the gravidity, number of cesarean section, maternal age, and serum level of PLGF (p< /001); while in VEGF, the difference was not statistically significant. ConclusionsThe results of the present study revealed that the maternal serum level of PLGF could be considered as an accurate predictive test in patients with PAS. BackgroundWith the rising rate of cesarean section (C/S) worldwide, placenta accreta is considered as a new pathological matter [1]. According to the depth of invasion of placenta to myometrium, the placenta accreta spectrum (PAS), formerly known as morbidly adherent placenta, is divided into three groups: placenta accreta with superficial myometrial invasion, placenta increta with deep myometrial invasion, and placenta percreta with deep invasion of placenta to serosa of uterus and sometime to adjacent organs [1,2].In normal placentation, extravillous trophoblasts containing interstitial and endovascular cells invade decidua and superficial myometrium and cause remodeling of the basilar and spiral artery [3, 4].Thus, excessive trophoblastic invasion, abnormal decidualization, abnormal angiogenesis, and 4 decrease of apoptosis of trophoblasts can result in abnormal adherence of placenta [5, 6].In uterine scars such as site of C/S, total or partial absence of decidua, thinning, irregularity or absence of Nitabuch's layer, and subsequently, placenta accreta can happen [4,[7][8][9].Also, deficient trophoblastic invasion can be harmful and is related to abortion, preeclampsia, intrauterine growth restriction (IUGR), and preterm delivery [3].The most important risk factors of PAS are previous C/S and intrauterine operation [10][11][12]. Other risk factors included placenta previa, multiparity, maternal age, any previous uterine surgery, surgical abortion, radiation, endometrial ablation, in vitro fertilization (IVF), chemotherapy, and adenomyosis [7,[10][11][12].The rate of C/S in the United States is 32-33% and placentas accreta is equal to 1/540-1/2500 of total deliveries[1]. It has increased...

Maternal urinary vascular endothelial growth factor (VEGF) versus N.T. pro brain natriuretic peptide (NT-pro BNP) as novel biomarkers for placental accreta spectrum (PAS): A case-control study

“…The author reported that the serum level of VEGF showed no difference between both groups. 14 The case-control study of Faraji et al, 2021, aimed to assess the maternal serum level of VEGF and PLGF in the diagnosis of the PAS. It included 90 pregnant women, divided in two groups (PAS, n=45) and (Normal Placenta, n=45).…”