Second Trimester Biochemical Markers as Possible Predictors of Pathological Placentation: A Retrospective Case-Control Study

Turhan

Z Geburtshilfe Neonatol

et al. 2021

Objective To evaluate whether placental protein-13 (PP-13) measured in the serum of pregnant women could predict abnormal invasive placentation (AIP) detected by color Doppler ultrasound (US) and magnetic resonance imaging scan in addition to the routine US scan during the third trimester. Materials and methods The prospective case-control study included patients subdivided in 2 groups: 42 pregnant women with a singleton pregnancy at 28–32 weeks of gestation with only suspected AIP, and 32 healthy pregnant women. The serum PP-13 levels were measured in both groups using an enzyme-linked immunosorbent assay (ELISA) method and statistically compared. The cases of AIP were confirmed by placental histopathological examination and/or the uterus removed by hysterectomy after elective caesarean section. Results Serum PP-13 levels of pregnant women with AIP were significantly higher (p<0.001) than those of controls (650.32±387.33 vs. 231.43±94.33). Statistical analysis of maternal serum PP-13 levels above the threshold of 312 pg/ml (measured in the early third trimester) predicted AIP with 76.2% sensitivity and 75% specificity. Conclusion Maternal serum PP-13 may have a role in the pathophysiology of AIP owing to its high serum value in the AIP group. The maternal serum dosage of PP-13 levels could improve pregnancy management in those patients suspected of having AIP.

Section: Discussionmentioning

confidence: 99%

Maternal Serum Placental Protein-13 Levels in the Prediction of Pregnancies with Abnormal Invasive Placentation

Turhan

Z Geburtshilfe Neonatol

et al. 2021

“…25 Both AFP and hCG in the second trimester was also associated with pathologic placentation. 29 Elevated inhibin A, which is secreted from the corpus luteum and feto-placental unit, 30 is also associated with accelerated differentiation of cytotrophoblast and alterations of syncytiotrophoblast morphology, 31 being a marker of placental oxidative stress. 32…”

Section: Discussionmentioning

confidence: 99%

Predictive value of quad serum markers for adverse pregnancy outcome in antiphospholipid antibody syndrome

Hong

Kim

et al. 2021

Lupus

Purpose We investigated the validity of quad serum markers for the prediction of adverse pregnancy outcome (APO) in women with antiphospholipid antibody syndrome (APS). Methods We included 75 women with APS delivered at our institution. APO was defined as stillbirth, small for gestational age (SGA), severe preeclampsia, or preterm delivery. First, we compared clinical characteristics between patients with or without composite APO. Second, we compared the rate of APO according to abnormal level of quad serum markers. Lastly, receiver operating characteristic (ROC) curve analysis was performed. Results APS mothers with APO showed higher median α-fetoprotein (AFP) and inhibin A compared with those without APO. They were also associated with higher rates of positive risk of Down syndrome and neural tube defect. Elevated AFP, human chorionic gonadotropin (hCG), and inhibin A level was associated with higher rates of stillbirth, SGA, preterm delivery, and composite APO. ROC curve for prediction of stillbirth revealed an area under the curve of 0.835 for AFP, 0.781 for hCG, and 0.932 for inhibin A. For composite APO, the area under the ROC curve was 0.692 for AFP and 0.810 for inhibin A. Conclusion Elevated AFP, hCG, and inhibin A in women with APS demonstrated a high predictive value for APO, especially stillbirth.

“…Increased levels of biological markers, such as hCG in maternal serum are thought to result from early placental vascular damage and possibly be due to their greater absorption into maternal blood ow 11 . Berezowsky et al found that second trimester hCG levels were signi cantly higher among cases of pathological placentation, such as those in the spectrum of placenta previa and placenta accreta 12 . Interestingly, we found higher levels of hCG the longer the LLP persisted.…”

Section: Discussionmentioning

confidence: 99%

A New Model for Early Prediction of Persistent Low-Lying Placenta

Farladansky-Gershnabel

Gluska

Sharon-Weiner

et al. 2021

Preprint

Objective Finding a predictive model for persistent low lying placenta (LLP) based on early clinical and laboratory parameters. Methods This retrospective cohort study included patients with LLP detected during early anatomy scan. Additional transvaginal ultrasound exams assessed for resolution at 22–24 weeks and 36–39 weeks. Patients were categorized as: Group 1–LLP resolved by the second trimester scan, Group 2- LLP resolved by the third, and Group 3–LLP persisted to delivery. Clinical and laboratory parameters were compared between groups. A linear support vector machine classification was used to define a prediction model for persistence. Results Among 236 pregnancies with LLP, 80% resolved by 22–24 weeks, 10.5% resolved by 36–39 weeks and 9.5% persisted until delivery. Second trimester hCG levels were higher the longer the LLP persisted (0.8MoM + 0.7 vs. 1.13MoM + 0.4 vs. 1.7MoM + 1.5, P = 0.03, respectively) and Cervical length was shorter (P = 0.008, P = 0.02, respectively). A linear SVM classification model was calculated based on these parameters. The predictive accuracy of this model was 90.3%. Conclusion LLP persistence can be predicted with an accuracy of 90.3%, as early as the beginning of the second trimester. Persistence vs. resolution of LLP may represent different entities and not a spectrum of the same condition over time.