Second-trimester prediction of severe placental complications in women with combined elevations in alpha-fetoprotein and human chorionic gonadotrophin

Mid-Trimester Maternal Serum hCG and AFP Levels: Clinical Significance and Prediction of Adverse Pregnancy Outcome

“…Increased impedance and reduced blood flow in the uterine arteries associated with subsequent development of pregnancy complications characterized by spiral artery vasculopathy (preeclampsia, IUGR, IUFD) (3, 51,52). Also, reduced uteroplacental blood flow is more prevalent in women with elevated mid-trimester ms-hCG and/or ms-AFP levels and may be a useful marker for the subset of women with increased risk to develop pregnancy complications (late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD) (3, 23, 48, 53, 54). Likewise, abnormalities of placental shape or texture in women with elevated mid-trimester ms-AFP levels have been associated with poor pregnancy outcome (48).…”

“…Also, reduced uteroplacental blood flow is more prevalent in women with elevated mid-trimester ms-hCG and/or ms-AFP levels and may be a useful marker for the subset of women with increased risk to develop pregnancy complications (late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD) (3, 23, 48, 53, 54). Likewise, abnormalities of placental shape or texture in women with elevated mid-trimester ms-AFP levels have been associated with poor pregnancy outcome (48). However, uterine artery Doppler screening alone is superior to mid-trimester ms-hCG and ms-AFP screening to identify a significant placental pathology leading to pregnancy complications (55).…”

“…In the absence of fetal chromosomal or structural anomalies, combined mid-trimester elevation in ms-hCG and ms-AFP levels suggest a more complex type of placental pathology which have stronger association with pregnancy complications including: late fetal loss [OR 7.05 (95% CI: 1.18-29.88)], gestational hypertension [OR 0.78 (95% CI: 0.13-3.24)], preeclampsia [OR 6.67 (95% CI: 3.84-11.58)], IUGR [OR 3.54 (95% CI: 1.26-9.14)], preterm delivery [OR 3.20 (95% CI: 1.49-6.61)] and IUFD [OR 6.87 (95% CI: 1.71-22.93)] (3, 4, 23-25, 39, 46, 47). Placental pathology studies suggest that unexplained combined mid-trimester elevation in ms-hCG and ms-AFP levels associated with villitis and placental vascular lesions (48). …”

Fetal growth restriction: aetiology, screening, diagnosis and management

“…[56][57][58] ultrasound assessment, using uterine artery doppler and placental morphology, is of value to distinguish a subset of pregnancies at high risk of early severe FGR. [59][60][61] In women with risk factors for intrauterine growth restriction, uterine artery doppler screening at 19 to 23 weeks may identify pregnancies at risk of antepartum stillbirth and preterm delivery due to intrauterine growth restriction and placental disease. 62 In pregnancies in which intrauterine growth restriction due to uteroplacental vascular insufficiency is diagnosed, maternal surveillance for the development of severe preeclampsia with adverse features is warranted.…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…With ongoing suspicion of preeclampsia, a change in maternal or fetal status should prompt repeat testing. Abnormalities of Doppler-based assessment of the uterine or fetal circulations warrant obstetric consultation as they reflect elevated risks of adverse outcomes and results may inform timing of delivery [119][120][121][122][123][124][125][126]. Consultation may be practically limited to telephone.…”