Angiogenic factors for the prediction of pre-eclampsia in women with abnormal midtrimester uterine artery Doppler velocimetry

Abstract

Objective To determine whether assessing uterine perfusion and angiogenic factors concurrently in the second trimester improves the prediction of pre-eclampsia and intrauterine growth restriction (IUGR). Method Plasma levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured for 108 women with abnormal uterine perfusion on Doppler velocimetry in the 23rd week. Later, 33 cases of pre-eclampsia and 9 of IUGR developed. Results Compared with the plasma levels of the women whose pregnancies remained normal, sFlt-1 levels were significantly higher and PlGF levels significantly lower in the women whose pregnancies became complicated by pre-eclampsia and/or IUGR ( P < 0.001). The alterations were more pronounced in cases of early-onset pre-eclampsia and in cases of IUGR that necessitated delivery before 34 weeks. Using the sFlt-1/PlGF ratio, these complications could be predicted with 98% sensitivity, 95% specificity, and 93% positive predictive value. Conclusion Measuring uterine perfusion and angiogenic factors concurrently in the second trimester improved the prediction of pre-eclampsia and IUGR.