sFlt-1/PlGF ratio for the prediction of the time of delivery
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The soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio has been shown to be a useful parameter for the diagnosis and prediction of preeclampsia (PE). An increased sFlt-1/PlGF ratio can be closely linked to the need to deliver. The aim of the study was to examine the mean time until delivery (MTUD) in pregnant women with a strongly increased sFlt-1/PlGF ratio.
From 2010 to 2018, the sFlt-1/PlGF ratio was determined in 995 singleton pregnancies with diagnosis or suspicion of PE/HELLP syndrome and/or intrauterine growth restriction (IUGR). MTUD of patients with a value above 655 in < 34 weeks of gestation (group 1: n = 13) and above 201 in ≥ 34 weeks of gestation (group 2: n = 15) was calculated. Patients with a value > 85 but < 655 in < 34 weeks of gestation (group 3: n = 70) and a value > 110 but < 201 (group 4: n = 44) in ≥ 34 weeks of gestation acted as controls.
28 pregnant women with severely elevated sFlt-1/PlGF ratio and 114 controls were included. In group 1, MTUD was longer compared to group 2 without reaching statistical significance (96.7 h ± 132.2 vs. 47.7 h ± 44, p = 0.222). In pregnancies < 34 weeks of gestation (early onset), MTUD was significantly longer in group 3 compared to group 1 (361 h ± 317.3 vs. 96.7 h ± 132.2, p < 0.001). In pregnancies ≥ 34 weeks of gestation (late onset), MTUD was significantly longer in group 4 compared to group 2 (123.6 h ± 139.2 vs. 47.7 h ± 44, p = 0.002).
The sFlt-1/PlGF ratio is suitable for decision-making regarding close monitoring of high-risk patients and need for lung maturation. However, for planning of delivery itself further prospective interventional studies are required to define its role as outcome predictor.
KeywordsPreeclampsia Antiangiogenic factors Placental growth factor Soluble fms-like tyrosine kinase Intrauterine growth restriction
OG: project development, data collection, data analysis, and manuscript writing. SML: data analysis and manuscript editing. JUO: manuscript editing. AK: data collection and manuscript editing. BK: project development, data collection, data analysis, and manuscript editing.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Verlohren S, Herraiz I, Lapaire O, Schlembach D, Moertl M, Zeisler H, Calda P, Holzgreve W, Galindo A, Engels T, Denk B, Stepan H. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 2012; 206:58.e1–8Google Scholar
- 6.Lobmaier SM, Figueras F, Mercade I, Perello M, Peguero A, Crovetto F, Ortiz JU, Crispi F, Gratacós E (2014) Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late-pregnancy small-for-gestational-age fetuses. Ultrasound Obstet Gynecol 43(5):533–540CrossRefPubMedGoogle Scholar
- 9.015/018—S1-Leitlinie: Diagnostik und Therapie hypertensiver Schwangerschaftserkrankungen aktueller Stand: 12/2013. http://www.awmf.org/uploads/tx_szleitlinien/015018l_S1_Diagnostik_Therapie_hypertensiver_Schwangerschaftserkrankungen_2014-verlaengert.pdf
- 13.Stepan H, Herraiz I, Schlembach D, Verlohren S, Brennecke S, Chantraine F, Klein E, Lapaire O, Llurba E, Ramoni A, Vatish M, Wertaschnigg D, Galindo A (2015) Implementation of the sFlt1/PlGF ratio for prediction and diagnosis of preeclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstet Gynecol 45:241–246CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Lees CC, Marlow N, van Wassenaer-Leemhuis A, Arabin B, Bilardo CM, Brezinka C, Calvert S, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KT, Thilaganathan B, Todros T, Valcamonico A, Visser GH, Wolf H, TRUFFLE study group (2015) 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet. 385(9983):2162–2172CrossRefPubMedGoogle Scholar
- 15.Klein E, Schlembach D, Ramoni A, Langer E, Bahlmann F, Grill S, Schaffenrath H, van der Does R, Messinger D, Verhagen-Kamerbeek WD, Reim M, Hund M, Stepan H (2016) Influence of the sFlt-1/PlGF Ratio on Clinical Decision-Making in Women with Suspected Preeclampsia. PLoS One 11(5):e0156013CrossRefPubMedPubMedCentralGoogle Scholar