Outcomes of pregnancies in women with extremely high ratio of sFlt-1 / PlGF: a series of clinical cases

Abstract

Preeclampsia as one of the manifestations of placental dysfunction associated with dysregulation of pro- and antiangiogenic factors. During normal pregnancy, the concentration of antiangiogenic factor sFlt-1 remains low, which allows accurate transmission of signals induced by proangiogenic factors VEGF and PlGF. This balance is crucial to maintain physiological vasodilation. Under hypoperfusion, the placenta increases the synthesis of sFlt-1, trying to increase maternal pressure and increase placental perfusion.The objective: to study the clinical outcomes of pregnancies in a group with extremely high ratios of sFlt-1 and PlGF.Materials and methods. The results of determining the levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase (sfLT-1), which were performed during 2017-2020 in the serum of 128 pregnant women at 18–39 weeks, were analyzed.Results. The mean age of pregnant women was 28,4±4 years. The average gestational age during the study was 26±5 weeks. The majority of pregnant women had signs of IUGR (62,5%) and/or preeclampsia (50%) during the study. The average level of the sFlt/PIGF ratio was 1747 pg/ml. In 100% of cases with a digital ratio of more than 850, signs of an obstetric angiogenic catastrophe that required immediate delivery developed during the nearest future. The average time from analysis to delivery was 10 days. In 50% of pregnant women, urgent delivery was required within 48 hours after analysis. Favorable neonatal results were observed in 37,5% of women.Conclusion. We found a tendency for worsening perinatal outcomes in women with extremely high sFlt-1/PlGF ratios after reaching 850. Careful monitoring of the pregnant woman and consideration of need for prophylactic administration of corticosteroids to accelerate fetal lung maturation in this group is rational.