497: Angiogenic factors vs. standard evaluation in the prediction of adverse outcome among pregnancies with suspected fetal growth restriction

Abstract

Prediction of adverse neonatal outcome in growth restricted fetuses (FGR) is challenging. Currently, standard evaluation includes Doppler surveillance and repeated clinical assessments. While this management protocol identifies most anticipated complications, some cases are missed and the health-care provider’s ability to predict adverse outcome may be improved. We studied the added value of angiogenic factors in management of FGR cases for the prediction of adverse perinatal outcomes. This prospective cohort study included hospitalized women with singleton pregnancies diagnosed with FGR between 24 and 35+6 weeks’ gestation (n=58). At hospitalization blood was drawn from women for sFlt-1 and PlGF measurements. Hence, three attending maternal-fetal medicine (MFM) assessed the risk of these pregnancies to develop adverse neonatal outcome (blinded), after examining the available maternal and pregnancy data upon admission. Data presented included: Doppler surveillance, clinical data and obstetrical history. The specialists predicted the risk (1-5 scale) for adverse neonatal outcome defined as: prolong NICU hospitalization, IVH, ARDS, NEC, convulsions and death. A given score of above 2 (scale of 1-5) was considered a high predicted risk for developing a complication. A score of over 14.5 multiple of the expected median (MoM) in the sFlt-1/ PlGF ratio was defined as a high predicted risk for complication. To describe performance, receiver-operating characteristic (ROC) curves were constructed for biochemical markers and clinical prediction. Disagreement between specialists was defined as a difference of 2 points or more in a given score. Of the 58 FGR cases included, 30 were complicated by adverse neonatal outcome (52%). The predictive values of the clinical assessments and of the bio-marker ratios are presented in the Table. Areas under the curve (AUCs)are presented in the Figure. Disagreement between specialists was identified in 19 cases - 32%. In 18 (95%) of these cases the marker predicted outcome accurately. Maternal serum sFlt-1/PlGF ratio can substantially improve clinical prediction of adverse neonatal outcome in FGR management. Furthermore, these biochemical tools appear to have a unique role in cases of disagreement between MFM specialists managing these cases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)