Prediction of adverse perinatal outcome by serum placental growth factor and soluble fms‐like tyrosine kinase‐1 in women undergoing induction of labor

Abstract

Objective To investigate the additive value of serum placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1), measured within 24 h prior to induction of labor, to the performance of screening for adverse perinatal outcome provided by maternal risk factors and the cerebroplacental ratio (CPR). Methods This was a prospective observational study of 795 singleton pregnancies undergoing induction of labor at ≥ 37 weeks' gestation. Before induction of labor, Doppler ultrasound was used to measure the pulsatility index (PI) in the umbilical artery (UA) and fetal middle cerebral artery (MCA) and maternal blood was obtained for measurement of serum PlGF and sFlt‐1. The measured UA‐PI, MCA‐PI and their ratio (CPR) were converted to multiples of the median (MoM) after adjustment for gestational age, and the measured PlGF and sFlt‐1 were converted to MoM after adjustment for gestational age, maternal characteristics and the machine used for the assays. Univariable and multivariable logistic regression analysis was used to determine factors that provided a significant contribution in the prediction of adverse perinatal outcome, defined as the presence of any one of Cesarean section for non‐reassuring fetal status in labor, umbilical arterial or venous cord blood pH ≤ 7 and ≤ 7.1, respectively, 5‐min Apgar score < 7 or admission to the neonatal intensive care unit for ≥ 24 h. The detection rate (DR) and false‐positive rate (FPR) in screening for adverse perinatal outcome were determined. Results In pregnancies with adverse perinatal outcome, compared to those without, median serum PlGF MoM was lower (0.44; interquartile range (IQR), 0.30–0.82 vs 0.60; IQR, 0.36–1.07; P = 0.003), but median sFlt‐1 MoM was not significantly different (P = 0.080). Multivariable regression analysis demonstrated that, in the prediction of adverse perinatal outcome, there was significant contribution from maternal risk factors and CPR MoM but not PlGF MoM or sFlt‐1 MoM. The performance of screening for adverse perinatal outcome achieved by maternal risk factors alone (DR of 28.9% at FPR of 10%) was not improved by the addition of CPR (DR of 33.8% at FPR of 10%) (area under the curve, 0.702; 95% CI, 0.654–0.750 vs 0.712; 95% CI, 0.664–0.760; P = 0.233). Conclusion Serum PlGF and sFlt‐1, measured within 24 h prior to induction of labor, do not provide a significant additional contribution to maternal risk factors in the prediction of adverse perinatal outcome. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Clinical application of exosomes and circulating microRNAs in the diagnosis of pregnancy complications and foetal abnormalities

“…The maternal peripheral blood contains a variety of factors that reflect pregnancy status, such as blood glucose, glycocholic acid, soluble Fms-like tyrosine kinase-1, and circulating foetal DNA [4,5]. Recent studies have confirmed that exosomes and circulating miRNAs exist in peripheral blood and are involved in a variety of physiological and pathological processes [6].…”

New Markers for Placental Dysfunction at Term – Potential for More

“…The authors did not find any added value using sFlt-1/PlGF with regard to the prediction of APO compared to only using maternal risk factors (+/− CPR). Nevertheless, a decreased PIGF serum level was significantly associated with an APO [50]. Another prospective blinded study (n = 207) of a low-risk population went through weekly PIGF and CPR measurements from 36 + 0 WG onwards.…”

“…Die Autoren fanden keinen Mehrwert von sFlt-1/PlGF bezogen auf die APO-Prädiktion im Vergleich zur alleinigen Verwendung von mütterlichen Risikofaktoren (+/− CPR). Dennoch zeigte sich ein erniedrigter PlGF-Serumspiegel signifikant assoziiert mit einem APO 50 . In einer prospektiv-verblindeten Studie (n = 207) im Low-Risk-Kollektiv wurde ab 36 + 0 SSW wöchentlich PlGF bestimmt sowie die CPR gemessen.…”

Middle Cerebral Artery-to-Uterine Artery Pulsatility Index Ratio Independently Predicts Adverse Perinatal Outcome in Pregnancies at Term

“…An adverse perinatal outcome was set as the primary observational endpoint. According to the de nitions by previous studies (12,13), the adverse perinatal outcome includes stillbirth, early neonatal death, neonatal intensive care unit (NICU) admission ≥ 24h, Apgar score < 7 at 5 min, cesarean section for nonreassuring fetal status, meconium stained amniotic uid, respiratory distress requiring oxygen support and mechanical ventilation, necrotizing enterocolitis, sepsis, hypothermia, and hypoglycemia.…”