Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio
Por:
Villalain, C, Herraiz, I, Valle, L, Mendoza, M, Delgado, JL, Vazquez-Fernandez, M, Martinez-Uriarte, J, Melchor, I, Caamina, S, Fernandez-Oliva, A, Villar, OP, Galindo, A
Publicada:
9 abr 2020
Resumen:
BACKGROUND: 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 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 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 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. CONCLUSIONS: An sFlt--1/ PlGF 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.
Filiaciones:
Villalain, C:
Univ Complutense Madrid, Hosp Univ 12 Octubre, Hosp 12 Octubre imas12,Inst Invest, Fetal Med Unit SAMID,Dept Obstet & Gynaecol, Madrid, Spain
Herraiz, I:
Univ Complutense Madrid, Hosp Univ 12 Octubre, Hosp 12 Octubre imas12,Inst Invest, Fetal Med Unit SAMID,Dept Obstet & Gynaecol, Madrid, Spain
Valle, L:
Hosp Univ Materno Infantil Las Palmas Gran Canari, Dept Obstet, Las Palmas Gran Canaria, Spain
Mendoza, M:
Univ Autonoma Barcelona, Vall dHebron Univ Hosp, Maternal Foetal Med Unit SAMID, Dept Obstet, Barcelona, Spain
Delgado, JL:
Hosp Univ Virgen Arrixaca, Dept Obstet & Gynecol, Murcia, Spain
Vazquez-Fernandez, M:
Hosp Univ Cent Asturias, Dept Obstet, Asturias, Spain
Martinez-Uriarte, J:
Hosp Gen Univ Santa Lucia, Dept Obstet & Gynecol, Cartagena, Spain
Melchor, I:
Cruces Univ Hosp UPV EHU, Biocruces Bizkaia Hlth Res Inst, Obstet & Gynecol Dept, Vizcaya, Spain
Caamina, S:
Hosp Univ Nuestra Senora Candelaria, Dept Obstet & Gynecol, Santa Cruz De Tenerife, Spain
Fernandez-Oliva, A:
Hosp Santa Creu & Sant Pau, Dept Obstet & Gynecol, Maternal Foetal Med Unit, Barcelona, Spain
Villar, OP:
Univ Complutense Madrid, Hosp Univ 12 Octubre, Hosp 12 Octubre imas12,Inst Invest, Fetal Med Unit SAMID,Dept Obstet & Gynaecol, Madrid, Spain
Galindo, A:
Univ Complutense Madrid, Hosp Univ 12 Octubre, Hosp 12 Octubre imas12,Inst Invest, Fetal Med Unit SAMID,Dept Obstet & Gynaecol, Madrid, Spain
Gold, Green Published
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