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Role of sFlt-1/PlGF ratio and feto-maternal Doppler for the prediction of adverse perinatal outcome in late-onset pre-eclampsia

  • Maternal-Fetal Medicine
  • Published:
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Abstract

Purpose

The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio and uterine artery Doppler have shown to be helpful in the diagnosis of pre-eclampsia (PE). The predictive value of the cerebroplacental ratio (CPR) regarding adverse perinatal outcome (APO) in low-risk pregnancies is intensively discussed. We evaluated the extent to which sFlt-1/PlGF ratio and feto-maternal Doppler may be useful in predicting APO in singleton pregnancies complicated by late-onset PE and/or HELLP syndrome.

Methods

This is a retrospective study from 2010 to 2018 consisting of singleton pregnancies with confirmed diagnosis of late-onset (lo ≥ 34 weeks) PE/HELLP syndrome in which sFlt-1/PlGF ratio and feto-maternal Doppler (mUtA-PI: mean uterine artery pulsatility index and CPR) were determined. The ability of sFlt-1/PlGF ratio, mUtA-PI, CPR and their combination to predict APO or SGA was evaluated using receiver operating characteristic (ROC) curves.

Results

67 patients were included in the final analysis. Of these, sFlt-1/PlGF was > 110 (defining angiogenic lo PE) in 40.3% (27/67), mUtA-PI was above the 95th centile in 34.3% (23/67) patients and CPR was lower than the 5th centile in 10.4% (7/67). Abnormal sFlt-1/PlGF and mUtA-PI as well as CPR were associated with a lower birth weight (BW). Late-preterm birth (< 37 weeks) as well as postnatal diagnosis of small for gestational age (SGA: BW < 3rd centile) was significantly more often in angiogenic lo PE cases. Neither sFlt-1/PIGF nor CPR or mUtA-PI were APO predictors. Only for sFlt-1/PlGF, ROC analysis revealed a significant predictive value for postnatal SGA (AUC = 0.856, p = 0.001, 95% CI 0.75–0.97). There was no statistical added value of combined SGA predictors as compared to sFlt-1/PlGF alone.

Conclusions

In patients with lo PE, adding sFlt-1/PlGF ratio to routine antepartum fetal surveillance may be useful to identify cases of postnatal SGA. However, further prospective studies are warranted to define the role of feto-maternal Doppler and sFlt-1/PlGF ratio as outcome predictors.

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Author notes

  1. Oliver Graupner and Anne Karge share equal contribution as first authors.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Oliver Graupner, Anne Karge, Sarah Flechsenhar, Alina Seiler, Javier U. Ortiz, Silvia M. Lobmaier, Kathrin Abel & Bettina Kuschel

  2. Institute for Medical Informatics, Statistics and Epidemiology (IMedIS), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany

    Bernhard Haller

  3. Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany

    Roland Axt-Fliedner & Christian Enzensberger

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  1. Oliver Graupner
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  3. Sarah Flechsenhar
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Contributions

OG: Project development, Data collection, Data analysis, Manuscript writing. AK: Data collection, Manuscript writing. SF: Data collection, Manuscript editing. AS: Data collection, Data analysis, Manuscript editing. BH: Data analysis, Manuscript editing. JUO: Manuscript editing. SML: Manuscript editing. RA-F: Project development, Manuscript editing. CE: Manuscript editing. KA: Manuscript editing. BK: Project development, Data collection, Data analysis, Manuscript editing.

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Correspondence to Oliver Graupner.

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Graupner, O., Karge, A., Flechsenhar, S. et al. Role of sFlt-1/PlGF ratio and feto-maternal Doppler for the prediction of adverse perinatal outcome in late-onset pre-eclampsia. Arch Gynecol Obstet 301, 375–385 (2020). https://doi.org/10.1007/s00404-019-05365-9

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