The Role of Placental Growth Factor, Soluble Endoglin, and Uterine Artery Diastolic Notch to Predict the Early Onset of Preeclampsia

Abstract

BACKGROUND: Reducing maternal mortality is one of the targets in the Millennium Development Goals (MDGs). In a systematic review, 4.6 per cent (95% CI 2.7-8.2) of pregnancies were complicated by preeclampsia worldwide. Preeclampsia occurs in around 10% of pregnancies in the world whereas developing countries contribute more than developed countries. In developing countries, there are 13 cases of preeclampsia in every 1,000 births, whereas in developed countries only 2-3 cases of preeclampsia are found in every 10,000 deliveries. Variations in prevalence among countries reflect, at least in part, differences in the distribution of maternal age and the proportion of nulliparous pregnant women in the population.
 AIM: We aimed to investigate the role of placental growth factor, soluble endoglin, and uterine artery diastolic notch to predict the early onset of preeclampsia.
 METHODS: This study used an analytical study with a nested case-control design. The study was conducted at Bunda Thamrin Hospital, Tanjung Mulia Mitra Medika Hospital, Sundari Hospital and a private clinic, from March to November 2018 with a total sample of 70 research subjects.
 RESULTS: Uterine artery diastolic notch was not found in 50% of subjects. A total of 27 subjects (38.6%) had a unilateral diastolic notch, and 8 subjects (11.4%) had a bilateral diastolic notch. Cut-off point PIGF levels was 441 pg/ml, and Area Under Curve (AUC) 82.5% (95% CI 61.5%-100%), with sensitivity 80% and specificity 87.7%. The levels sEng in this study could not predict the incidence of early-onset preeclampsia (p = 0.113). Combined PlGF and pulsatile index of uterine arteries may predict early onset preeclampsia with sensitivity 40% and specificity 90.77%. From these results, pregnant women o 22-24 weeks of pregnancy, the levels of PlGF and the uterine artery pulsatility index can be a predictor of early-onset preeclampsia. Examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia.
 CONCLUSION: From these results, it can be concluded that in pregnant women of 22-24 weeks, the diastolic notches in uterine arteries cannot predict the incidence of early-onset preeclampsia. PlGF levels and pulsatile index of uterine arteries can be used as predictors of early-onset preeclampsia although examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia.

Abnormal uterine artery Doppler ultrasound during gestational 21–23 weeks associated with pre‐eclampsia

“…7 The uterine artery PI at 22-24 weeks of pregnancy can be used as a predictor of earlyonset pre-eclampsia. 8 In an unselected population, conventional mid-trimester Doppler ultrasound of mean PI greater than the 90th centile was able to detect 59% of early-onset pre-eclampsia. 9 The inclusion of notch in the calculation further increased the prediction of pre-eclampsia.…”

“…However, there is also a part of the study that takes the opposite view. In a study including 70 pregnant women at 22–24 weeks, diastolic uterine artery notch did not predict the onset of early‐onset pre‐eclampsia 8 . Eighty‐eight pregnant women had bilateral uterine artery Doppler measurements performed at 20–24 weeks of pregnancy.…”

“…In a study including 70 pregnant women at 22-24 weeks, diastolic uterine artery notch did not predict the onset of early-onset pre-eclampsia. 8 Eighty-eight pregnant women had bilateral uterine artery Doppler measurements performed at 20-24 weeks of pregnancy. Uterine artery notch was not a significant predictor of pre-eclampsia.…”

“…The PI at 11–13 weeks of pregnancy is the best performing Doppler parameter in early pre‐eclampsia screening 7 . The uterine artery PI at 22–24 weeks of pregnancy can be used as a predictor of early‐onset pre‐eclampsia 8 . In an unselected population, conventional mid‐trimester Doppler ultrasound of mean PI greater than the 90th centile was able to detect 59% of early‐onset pre‐eclampsia 9 …”