Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio
Villalaín, Cecilia (Universidad Complutense de Madrid)
Herraiz, Ignacio (Universidad Complutense de Madrid)
Valle, Leonor (Complejo Hospitalario Universitario Insular Materno Infantil (Las Palmas de Gran Canaria))
Mendoza, Manel (Hospital Universitari Vall d'Hebron)
Delgado, Juan Luis (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Vázquez-Fernández, María (Hospital Universitario Central de Asturias)
Martínez-Uriarte, Juan (Hospital Virgen de La Luz (Cuenca))
Melchor, Íñigo (Hospital Universitario de Cruces (Barakaldo, País Basc))
Caamiña Álvarez, Sara (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Fernández-Oliva, Antonio (Institut d'Investigació Biomèdica Sant Pau)
Villar, Olga Patricia (Universidad Complutense de Madrid)
Galindo Tixaire, Alberto (Universidad Complutense de Madrid)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	There is little knowledge about the significance of extremely high values (>655) for the ratio of lt-1 (soluble fms-like tyrosine kinase 1) to Pl (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. 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 lt-1/Pl 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 preeclampsia 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 or 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 restriction), 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. An lt-1/Pl ratio >655 is almost invariably associated with preeclampsia or fetal growth restriction that progresses rapidly. In our tertiary care settings, we observed that maternal adverse outcomes were high throughout gestation, whereas perinatal adverse outcomes diminished as pregnancy advanced.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Fetal growth restriction ; Placental dysfunction ; Placental growth factor ; Preeclampsia ; Lt1 ; Pregnancy ; Angiogenesis ; Biomarkers
Publicat a:	Journal of the American Heart Association. Cardiovascular and cerebrovascular disease, Vol. 9 (april 2020) , ISSN 2047-9980

DOI: 10.1161/JAHA.119.015548
PMID: 32248765

12 p, 517.8 KB

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