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Title: | Maternal and perinatal outcomes associated with extremely high values for the sflt-1 (Soluble fms-like tyrosine kinase 1)/plgf (placental growth factor) ratio | Authors: | Villalaín, Cecilia Herraiz, Ignacio Valle Morales, Leonor Mendoza, Manel Delgado, Juan Luis Vázquez-Fernández, María Martínez-Uriarte, Juan Melchor, Íñigo Caamiña, Sara Fernández-Oliva, Antoni Villar, Olga Patricia Galindo, Alberto |
UNESCO Clasification: | 320108 Ginecología | Keywords: | Fetal growth restriction Placental dysfunction Placental growth factor Preeclampsia SFlt1 |
Issue Date: | 2020 | Journal: | Journal of the American Heart Association | Abstract: | There is little knowledge about the significance of extremely high values (>655) for the ratio of sFlt-1 (soluble fms-like tyrosine kinase 1) to PlGF (placental growth factor). We aim to describe the time-to-delivery interval and maternal and perinatal outcomes when such values are demonstrated while assessing suspected or confirmed placental dysfunction based on clinical or sonographic criteria. METHODS AND RESULTS: A multicenter retrospective cohort study was performed on 237 singleton gestations between 20+0 and 37+0 weeks included at the time of first demonstrating a sFlt-1/PlGF ratio >655. Clinicians were aware of this result, but standard protocols were followed for delivery indication. Main outcomes were compared for women with and without preec-lampsia at inclusion. In those with preeclampsia (n=185, of whom 77.3% had fetal growth restriction), severe preeclampsia features and fetal growth restriction in stages III or IV were present in 49.2% and 13.5% cases, respectively, at inclusion and in 77.3% and 28.6% cases, respectively, at delivery. In the group without preeclampsia (n=52, 82.7% had fetal growth restric-tion), these figures were 0% and 30.8%, respectively, at inclusion and 21.2% and 50%, respectively, at delivery. Interestingly, 28% of women without initial preeclampsia developed it later. The median time to delivery was 4 days (interquartile range: 1–6 days) and 7 days (interquartile range: 3–12 days), respectively (P<0.01). Overall, perinatal mortality was 62.1% before 24 weeks; severe morbidity surpassed 50% before 29 weeks but became absent from 34 weeks. Maternal serious morbidity was high at any gestational age. CONCLUSIONS: An sFlt-1/PlGF ratio >655 is almost invariably associated with preeclampsia or fetal growth restriction that pro-gresses rapidly. In our tertiary care settings, we observed that maternal adverse outcomes were high throughout gestation, whereas perinatal adverse outcomes diminished as pregnancy advanced. | URI: | http://hdl.handle.net/10553/111326 | ISSN: | 2047-9980 | DOI: | 10.1161/JAHA.119.015548 | Source: | Journal of the American Heart Association [ISSN 2047-9980], v. 9 (7), e015548 |
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