Prelabor screening for intrapartum fetal compromise in low‐risk pregnancies at term: cerebroplacental ratio and placental growth factor

Bligh, Larissa N.; Alsolai, Amal A.; Greer, Ristan M.; Kumar, Sailesh

doi:10.1002/uog.18981

Cited by 40 publications

(38 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In women at term, impaired placentation and fetal hypoxemia, reflected in low serum levels of the angiogenic placental growth factor (PlGF), high levels of the antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1) and reduced cerebroplacental ratio (CPR), are associated with increased risk of adverse perinatal outcome in both small-for-gestational-age (SGA) and non-SGA fetuses [1][2][3][4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

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

Fiolna

Machuca

Karampitsakos

et al. 2019

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Fiolna

Machuca

Karampitsakos

et al. 2019

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

show abstract

“…Furthermore, our model performs better than previous models constructed in specific high risk cohorts and by incorporating the use of EFW and CPR Z-scores as continuous measures we were able to show that the model performs well in a general cohort and improves in accuracy in the higher risk cohorts (75). There is also now evidence that the use of placental biomarkers such as placental growth factor may be useful for identifying vulnerable fetuses and future work needs to elucidate what role such biomarkers may have in similar models (187).…”

Section: Conclusion and Implications For Clinical Practicementioning

confidence: 68%

“…There is also now evidence that placental biomarkers such as the placental growth factor may be useful for identifying vulnerable fetuses (187,199). Work within our group has shown that in low risk term pregnancies, lower concentrations of maternal PLGF is associated with intrapartum fetal compromise as well as a composite outcome that comprised of abnormal cord gases and/or 5-minute Apgar <7 and/or admission to NICU (199).…”

Section: Future Directions For Researchmentioning

confidence: 95%

“…In a pilot study, the same team investigated the use of a combination of CPR and PLGF in predicting intrapartum fetal compromise and a composite neonatal outcome in low risk term pregnancies. They found that a model that combined both CPR and PLGF showed an improvement in diagnostic performance compared to the individual components for both intrapartum fetal compromise and for the composite neonatal outcome (187). Dunn and Kumar in another pilot study, showed that not only are PLGF levels are lower in pregnancies with intrapartum fetal compromise and composite neonatal outcomes but there is also a sharper decline in levels of PLGF in pregnancies complicated by intrapartum fetal compromise (200).…”

Section: Future Directions For Researchmentioning

confidence: 99%

“…It is possible however, that the addition of placental biomarkers may improve the performance of such models (20,187). Despite the above-mentioned caveats, our model could be used to guide prenatal decision making and may help guide clinical practice.…”

Section: Figure 7-3: Adjusted Probabilities Of Severe Adverse Neonatamentioning

confidence: 99%

See 2 more Smart Citations

Maternal and perinatal factors associated with adverse perinatal outcomes at term and the development of a predictive model for identification of at–risk pregnancies.

Flatley¹

View full text Add to dashboard Cite

The perinatal period is defined as being between 20 weeks gestation and up to 28 days after birth.Despite advancements in antenatal care, diagnostic tools, interventions and treatments, adverse perinatal outcomes such as stillbirth, fetal growth restriction, preterm birth, hypoxic ischaemic encephalopathy, serious neonatal morbidity and neonatal death still occur. Placental dysfunction is one of the major contributors to these adverse outcomes regardless of gestation. While the majority of fetuses are able to cope with the increase in metabolic requirements in the last few weeks of pregnancy, those with impaired placental function are more susceptible to hypoxic events leading to increased mortality, serious short-term morbidity and long-term neurodevelopmental delays including neonatal encephalopathy and cerebral palsy.Doppler assessment of fetal blood flow and fetal growth are effective methods to evaluate fetal wellbeing. The umbilical artery pulsatility index can identify growth restriction from suboptimal placentation. The middle cerebral artery pulsatility index can identify the "brain sparing" effect caused by increased perfusion of the fetal brain. The ratio of these two measures (middle cerebral artery pulsatility index/umbilical artery pulsatility index) known as the cerebroplacental ratio has been suggested to be a better predictor than the individual components. This thesis will investigate the associations between maternal and perinatal factors and adverse perinatal outcomes. It will assess Doppler indices for the identification of fetal growth restrictedsmall for gestational age fetuses and those at risk of emergency caesarean for non-reassuring fetal status. The creation of accurate reference centiles using the generalised additive model for location, scale and shape approach, will allow for meaningful interpretation of those Doppler measurements. This information will be used to create predictive tools that will enable the clinician to identify pregnancies at risk of adverse perinatal outcomes and emergency caesarean for non-reassuring fetal status.iii

show abstract

MicroRNA‐132 is overexpressed in fetuses with late‐onset fetal growth restriction

Roselló

Loscalzo

García-López

et al. 2022

Health Science Reports

View full text Add to dashboard Cite

Background and Aims To evaluate the expression of microRNA 132 (miR‐132) in fetuses with normal growth and in fetuses with late‐onset growth restriction (FGR). Methods In a prospective cohort study, 48 fetuses (24 with late‐onset FGR and 24 with normal growth) were scanned with Doppler ultrasound after 34 weeks to measure the umbilical artery and middle cerebral artery pulsatility indices and followed until birth. Subsequently, blood samples from the umbilical cord were collected to evaluate the expression of miR‐132 by means of Real‐time quantitative polymerase chain reaction, determining the existence of normality cut‐offs and associations with birth weight (BW) centile, cerebroplacental ratio multiples of the median (CPR MoM), and intrapartum fetal compromise (IFC). Results In comparison with normal fetuses, late‐onset FGR fetuses showed upregulation of miR‐132 (33.94 ± 45.04 vs. 2.88 ± 9.32 2−dd C t , p < 0.001). Using 5 as a cut‐off we obtained a sensitivity of 50% and a specificity of 96% for the diagnosis of FGR, while for IFC these values were respectively 27% and 73%. Expression of miR‐132 was associated with BW centile but not with CPR MoM. Finally, the best detection of IFC was achieved combining miR‐132 expression and CPR MoM (AUC = 0.69, p < 0.05). Conclusion Fetuses with late‐onset FGR show upregulation of miR‐132. Further studies are needed to investigate the role of miR‐132 in the management of late‐onset FGR.

show abstract

Prelabor screening for intrapartum fetal compromise in low‐risk pregnancies at term: cerebroplacental ratio and placental growth factor

Cited by 40 publications

References 30 publications

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

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

Maternal and perinatal factors associated with adverse perinatal outcomes at term and the development of a predictive model for identification of at–risk pregnancies.

MicroRNA‐132 is overexpressed in fetuses with late‐onset fetal growth restriction

Contact Info

Product

Resources

About