DOI: 10.1111/1471-0528.16401 BJOG Exchange www.bjog.org Authors’ reply re: Pre-eclampsia-like 37 weeks of gestation is extremely high References syndrome induced by severe (>97% for sFlt/PlGF <38) to exclude 1 Amorim M, Takemoto MLS, Katz L. Re: Pre- COVID-19: a prospective PE.4,5 For these reasons, we consider eclampsia-like syndrome induced by severe observational study that there is no reason to believe that COVID-19: a prospective observational study. sFlt-1/PlGF is not a good tool to exclude BJOG 2020; https://doi.org/10.1111/1471- 0528.16402. the diagnosis of PE in the context of 2 Mendoza M, Garcia-Ruiz I, Maiz N, Rodo C, Garcia- Sir, COVID-19. Manau P, Serrano B, et al. Pre-eclampsia-like Thank you kindly for the opportunity to Dr Amorim proposes that pre- syndrome induced by severe COVID-19: a respond to the letter from Dr Amorim eclampsia may act as a risk factor for prospective observational study. BJOG 2020; and her colleagues.1 We would like to developing severe or critical COVID-19. https://doi.org/10.1111/1471-0528.16339. 3 American College of Obstetricians and thank Dr Amorim and her team for We would recommend being cautious Gynecologists, Task Force on Hypertension in their interest in our study2 and their about this statement, as there is no Pregnancy. Hypertension in pregnancy. Report invaluable observations. evidence published to date supporting of the American College of Obstetricians and We acknowledge that our series is small this hypothesis and, in our series, the Gynecologists’ Task Force on Hypertension in and heterogeneous. Our patients ranged timeline of signs and symptoms is clear: Pregnancy. Obstet Gynecol 2013;122:1122–31. 4 Zeisler H, Llurba E, Chantraine F, Vatish M, Staff from 20 to 37 weeks of pregnancy and COVID-19 pneumonia occurred prior AC, Sennstro €m M, et al. Predictive value of the only in one case did the pre-eclampsia-like to features of pre-eclampsia. Neverthe- sFlt-1:PlGF ratio in women with suspected (PE-like) syndrome resolve sponta- less, we do agree with Dr Amorim and preeclampsia. N Engl J Med 2016;374:13–22. neously and without being delivered. her colleagues that our study is a small 5 Zeisler H, Llurba E, Chantraine FJ, Vatish M, We, therefore, cannot affirm that all cases series and further research is needed to Staff AC, Sennstro €m M, et al. Soluble fms-like tyrosine kinase-1 to placental growth factor were PE-like syndrome, as we acknowl- better understand the relation between ratio: ruling out pre-eclampsia for up to 4 edged in our article. PE and COVID-19. For this reason, we weeks and value of retesting. Ultrasound Although early and late pre-eclampsia are very much looking forward to Obstet Gynecol 2019;53:367–75. (PE) may not have the same patholog- finding out the results of Dr Amorim’s ical pathways, they do share the same study. Meanwhile, we believe that diagnostic criteria.3 We agree with Dr patients with signs and symptoms of Manel Mendoza, Itziar Garcia-Ruiz, Amorim and her colleagues that the PE in the context of severe COVID-19 Elena Carreras, & Anna Suy soluble fms-like tyrosine kinase-1 to should be managed with caution, as, in Maternal-Fetal Medicine Unit, Department of placental growth factor ratio (sFlt-1/ some cases, these signs and symptoms Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autonoma de PlGF) and mean uterine artery pulsatil- could be caused by COVID-19 and sFlt- Barcelona, Barcelona, Spain ity index (UtAPI) are generally predic- 1/PlGF might be helpful in the manage- tive of early forms of PE; nevertheless, ment of these pregnancies, especially in Accepted 2 July 2020. their negative predictive value before preterm cases. & DOI: 10.1111/1471-0528.16401 ª 2020 Royal College of Obstetricians and Gynaecologists 1