Abstract
PurposeThe study aimed to assess the course of the soluble Fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio in pregnant women with fetal growth restriction (FGR) and to evaluate potential associations between the sFlt-1/PlGF ratio and feto-maternal Doppler parameters, fetal biometric measurements and the time between study inclusion and birth (“time to delivery”).MethodsThis was a retrospective longitudinal single center study including 52 FGR cases. The serum levels of sFlt-1 and PlGF were measured by using the BRAHMS Kryptor Compact PLUS. Fetal biometric and Doppler parameters, as well as the sFlt-1/PlGF ratio, were obtained both upon study inclusion and upon birth.ResultsVarious associations between the levels of the biomarkers in maternal blood upon study inclusion and upon birth and sonographic parameters were observed in FGR cases: umbilical artery (p < 0.01), uterine arteries (p < 0.01), ductus venosus (p < 0.05), cerebroplacental ratio (CPR) (p < 0.01), femur length (p < 0.01) and birth weight (p < 0.01). The higher the sFlt-1/PlGF ratio upon study inclusion, the shorter the “time to delivery” (p < 0.01). The multivariate regression analysis showed that the greater the daily percentage increase of the angiogenic markers, the shorter the “time to delivery” (p < 0.01).ConclusionThe fetal well-being, as measured by feto-maternal Doppler parameters such as CPR and the severity of the placental dysfunction, as measured by the urgency of birth and birth weight, is reflected by the level of the sFlt-1/PlGF ratio in the maternal serum. A rapid daily increase of the sFlt-1/PlGF ratio is significantly associated with the clinical progression of the disease.
Highlights
The fetus suffering from fetal growth restriction (FGR) does not reach its genetically predetermined growth due to an underlying pathology [1]
This study aimed to assess the course of the soluble Fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio in pregnant women with FGR fetuses and to evaluate potential associations between the sFlt-1/PlGF ratio and feto-maternal Doppler parameters, fetal biometric measurements and the time between study inclusion and birth in FGR (“time to delivery”)
The result part is divided in three sections: 1. sFlt-1/PlGF ratio und its association with sonographic parameters
Summary
The fetus suffering from fetal growth restriction (FGR) does not reach its genetically predetermined growth due to an underlying pathology [1]. Uteroplacental insufficiency, which leads to oxygen deficiency for the fetus, appears to be the most common cause of FGR [2]. FGR is associated with increased rates of perinatal morbidity and mortality [3] and requires close monitoring. Depending on gestational age (GA) a distinction is made between earlyonset FGR (< 34th week of pregnancy) and late-onset FGR (≥ 34th week of pregnancy). Preeclampsia (PE) and FGR are two entities of impaired placental function, clinical and pathophysiological overlapping is common. The pathogenesis and etiology of placental dysfunction have not yet been fully elucidated,
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