Biophysical Markers of Suspected Preeclampsia, Fetal Growth Restriction and The Two Combined—How Accurate They Are?

Abstract

Objectives—To conduct a secondary analysis of prediction accuracy of biophysical markers for suspected Preeclampsia (PE), Fetal Growth Restriction (FGR) and the two combined near delivery in a Slovenian cohort. Methods—This was a secondary analysis of a database of a total 125 Slovenian pregnant women attending a high-risk pregnancy clinic due to suspected PE (n = 31), FGR (n = 16) and PE + FGR (n = 42) from 28–39 weeks gestation and their corresponding term (n = 21) and preterm (PTD, n = 15) controls. Data for Mean Arterial blood Pressure (MAP) and Uterine artery pulsatility index (UtA PI) estimated by Doppler sonography were extracted from the database of patients who were tested at admission to the high-risk clinic with the suspected complications. The reactive hyperemia index (RHI), and the Augmentation Index (AIX%) were extracted from the patient database using measured values obtained with the assistance of the Endo PAT, a device set to measure the signal of the peripheral arterial tone (PAT) from the blood vessels endothelium. Linear regression coefficients, Box and Whisker plots, Area under the Curve (AUC) of receiver Operation Characteristic (ROC) curves, and multiple regression were used to assess the marker accuracy using detection rate (DR) and false-positive rate (FPR) and previously reported cut-offs for estimating the positive and negative predictive value (NPV and PPV). The SPSS non-parametric statistics (Kruskal Wallis and Mann–Whitney) and Spearman’s regression coefficient were used to assess marker accuracy; p < 0.05 was considered significant. Results—MAP values reached diagnostic accuracy (AUC = 1.00, DR = 100%) for early PE cases delivered < 34, whereas UtA Doppler PI values yielded such results for early FGR < 34 weeks and the two combined reached such accuracy for PE + FGR. To reach diagnostic accuracy for all cases of the complications, the Endo PAT markers with values for MAP and UtA Doppler PI were required for cases near delivery. Multiple regression analyses showed added value for advanced maternal age and gestational week in risk assessment for all cases of PE, FGR, and PE + FGR. Spearman’s regression coefficient yielded r > 0.6 for UtA Doppler PI over GA for PE and FGR, whereas for RHI over BMI, the regression coefficient was r > 0.5 (p < 0.001 for each). Very high correlations were also found between UtA Doppler PI and sFlt-1/PlGF or PlGF (r = −0.495, p < 0.001), especially in cases of FGR. Conclusion—The classical biophysical markers MAP and UtA Doppler PI provided diagnostic accuracy for PE and FGR < 34 wks gestation. A multiple biophysical marker analysis was required to reach diagnostic accuracy for all cases of these complications. The UtA Doppler PI and maternal serum sFlt-1/PlGF or PlGF were equally accurate for early cases to enable the choice of the markers for the clinical use according to the more accessible method.

New immune horizons in therapeutics and diagnostic approaches to Preeclampsia

“…Using the patient's database reported in high-risk specialty clinic. 188 3. In a study performed on Asian females, 189 These are regarded as independent risk factors for developing PE.…”

“… Biophysical markers (MAP – mean arterial pressure and UAPI – uterine artery pulsatility index). Data for mean arterial blood pressure (MAP) and Uterine artery pulsatility index (UtA PI) were estimated by Doppler sonography. Using the patient's database reported in high‐risk specialty clinic 188 In a study performed on Asian females, 189 maternal blood pressure levels, uterine artery pulsatility index (UtA‐PI), serum sFlt‐1, PlGF, and sFlt‐1/PlGF ratio were measured at 11–14, 18–22, 28–32, and 34 weeks.…”

“…Data for mean arterial blood pressure (MAP) and Uterine artery pulsatility index (UtA PI) were estimated by Doppler sonography. Using the patient's database reported in high‐risk specialty clinic 188 …”

The Course of Pregnancy in Women With Preeclampsia Combined With Fetal Growth Retardation

“…Преэклампсия (ПЭ) и задержка роста плода (ЗРП) являются основными осложнениями беременности во многих странах, в том числе и в Азербайджане [12,13]. Существует сильная, но сложная взаимосвязь между ЗРП и ПЭ, что способствует созданию комбинированного осложнения [5].…”

“…В основе этой тенденции лежат различные плацентарные и сердечно-сосудистые механизмы: изолированное ограничение роста плода приводит к менее частым поражениям сосудов плаценты, чем ограничение роста плода, связанное с ПЭ; более того, при доношенных сроках ЗРП наблюдаются различные модели сердечного выброса матери и периферического сосудистого сопротивления по сравнению с ПЭ [5]. Эти патологии, поражающие 4-7% беременных, считаются связанными с хронической маточно-плацентарной гипоперфузией, имеют общие патофизиологические пути и связаны со сходными предрасполагающими факторами у женщин [5,13]. Преэклампсия -это специфический для беременности синдром, который может поражать несколько органов-мишеней [17].…”