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Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late‐pregnancy small‐for‐ gestational‐age fetuses
Author(s) -
Lobmaier S. M.,
Figueras F.,
Mercade I.,
Perello M.,
Peguero A.,
Crovetto F.,
Ortiz J. U.,
Crispi F.,
Gratacós E.
Publication year - 2014
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.13246
Subject(s) - medicine , soluble fms like tyrosine kinase 1 , fetus , obstetrics , small for gestational age , placental growth factor , pregnancy , uterine artery , gestational age , eclampsia , cohort , receiver operating characteristic , gestation , vascular endothelial growth factor , vegf receptors , biology , genetics
Objectives To compare the value of Doppler surveillance with maternal blood angiogenic factors at diagnosis for the prediction of adverse outcome in late‐pregnancy small‐for‐gestational‐age ( SGA ) fetuses. Methods In a cohort of 198 SGA fetuses we evaluated the association of Doppler indices (mean uterine artery pulsatility index ( UtA‐PI ) and cerebroplacental ratio ( CPR )) and angiogenic factors (maternal serum levels of soluble fms‐like tyrosine kinase‐1 ( sFlt ‐1) and placental growth factor ( PlGF )) with the development of pre‐eclampsia and adverse perinatal outcome (operative delivery for non‐reassuring fetal status or neonatal metabolic acidosis). Results In SGA fetuses subsequently developing pre‐eclampsia, mean UtA‐PI ( P < 0.001), sFlt ‐1 MoM ( P < 0.001) and sFlt ‐1/ PlGF MoM ratio ( P < 0.001) were higher, while PlGF MoM was lower ( P = 0.004). In SGA fetuses with adverse perinatal outcome, CPR ( P < 0.002) and PlGF MoM ( P < 0.001) were lower, and sFlt ‐1/ PlGF MoM ratio was higher ( P = 0.001). For predicting pre‐eclampsia, the areas under the receiver–operating characteristics ( ROC ) curves for mean UtA‐PI , sFlt ‐1 MoM and the combination of both were 0.852, 0.839 and 0.860, respectively. For adverse perinatal outcome, the areas under the ROC curves for CPR , PlGF MoM and the combination of both were 0.652, 0.656 and 0.684, respectively. The combination of Doppler indices and angiogenic factors did not significantly improve prediction of either pre‐eclampsia ( P = 0.851) or adverse outcome ( P = 0.579). Conclusions In SGA fetuses, angiogenic factors at diagnosis and follow‐up with Doppler ultrasound both predict adverse outcome with a similar performance. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.