Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio
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 dem...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.015548 |
| _version_ | 1818312538981400576 |
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| author | Cecilia Villalaín Ignacio Herraiz Leonor Valle Manel Mendoza Juan Luis Delgado María Vázquez‐Fernández Juan Martínez‐Uriarte Íñigo Melchor Sara Caamiña Antoni Fernández‐Oliva Olga Patricia Villar Alberto Galindo |
| author_facet | Cecilia Villalaín Ignacio Herraiz Leonor Valle Manel Mendoza Juan Luis Delgado María Vázquez‐Fernández Juan Martínez‐Uriarte Íñigo Melchor Sara Caamiña Antoni Fernández‐Oliva Olga Patricia Villar Alberto Galindo |
| author_sort | Cecilia Villalaín |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T08:19:27Z |
| format | Article |
| id | doaj.art-e9202a9593084428bb5c048e2955abba |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:19:27Z |
| publishDate | 2020-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e9202a9593084428bb5c048e2955abba2022-12-21T23:54:02ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-04-019710.1161/JAHA.119.015548Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) RatioCecilia Villalaín0Ignacio Herraiz1Leonor Valle2Manel Mendoza3Juan Luis Delgado4María Vázquez‐Fernández5Juan Martínez‐Uriarte6Íñigo Melchor7Sara Caamiña8Antoni Fernández‐Oliva9Olga Patricia Villar10Alberto Galindo11Fetal Medicine Unit‐SAMID Department of Obstetrics and Gynaecology Hospital Universitario 12 de Octubre Instituto de Investigación Hospital 12 de Octubre (imas12) Universidad Complutense de Madrid Madrid SpainFetal Medicine Unit‐SAMID Department of Obstetrics and Gynaecology Hospital Universitario 12 de Octubre Instituto de Investigación Hospital 12 de Octubre (imas12) Universidad Complutense de Madrid Madrid SpainDepartment of Obstetrics Hospital Universitario Materno‐Infantil de Las Palmas de Gran Canaria Las Palmas de Gran Canaria SpainDepartment of Obstetrics Maternal‐Foetal Medicine Unit‐SAMID Vall d’Hebron University Hospital Universitat Autònoma de Barcelona Barcelona SpainDepartment of Obstetrics and Gynecology Hospital Universitario Virgen de la Arrixaca Murcia SpainDepartment of Obstetrics Hospital Universitario Central de Asturias Asturias SpainDepartment of Obstetrics and Gynecology Hospital General Universitario Santa Lucía Cartagena SpainObstetrics and Gynecology Department Biocruces Bizkaia Health Research Institute Cruces University Hospital (UPV/EHU) Vizcaya SpainDepartment of Obstetrics and Gynecology Hospital Universitario Nuestra Señora de la Candelaria Santa Cruz de Tenerife SpainMaternal‐Foetal Medicine Unit Department of Obstetrics and Gynecology Hospital de la Santa Creu i Sant Pau Barcelona SpainFetal Medicine Unit‐SAMID Department of Obstetrics and Gynaecology Hospital Universitario 12 de Octubre Instituto de Investigación Hospital 12 de Octubre (imas12) Universidad Complutense de Madrid Madrid SpainFetal Medicine Unit‐SAMID Department of Obstetrics and Gynaecology Hospital Universitario 12 de Octubre Instituto de Investigación Hospital 12 de Octubre (imas12) Universidad Complutense de Madrid Madrid SpainBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.119.015548fetal growth restrictionplacental dysfunctionplacental growth factorpreeclampsiasFlt1 |
| spellingShingle | Cecilia Villalaín Ignacio Herraiz Leonor Valle Manel Mendoza Juan Luis Delgado María Vázquez‐Fernández Juan Martínez‐Uriarte Íñigo Melchor Sara Caamiña Antoni Fernández‐Oliva Olga Patricia Villar Alberto Galindo Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease fetal growth restriction placental dysfunction placental growth factor preeclampsia sFlt1 |
| title | Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio |
| title_full | Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio |
| title_fullStr | Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio |
| title_full_unstemmed | Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio |
| title_short | Maternal and Perinatal Outcomes Associated With Extremely High Values for the sFlt‐1 (Soluble fms‐Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio |
| title_sort | maternal and perinatal outcomes associated with extremely high values for the sflt 1 soluble fms like tyrosine kinase 1 plgf placental growth factor ratio |
| topic | fetal growth restriction placental dysfunction placental growth factor preeclampsia sFlt1 |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.015548 |
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