P 21 Clinical utility of sFlt1/PlGF in management of hypertensive pregnancies in India

Abstract

Introduction Timing of delivery among women with hypertension remains a balance between prevention of adverse maternal/fetal outcomes and gestational age of delivery. Angiogenic biomarkers have been researched to accurately predict adverse outcomes in women with hypertension, however their use in routine clinical care has not been studied. Objectives To study the outcomes of hypertensive pregnancies with real time assessment and incorporation of knowledge of sFlt1/PlGF ratio performed in the third trimester. Material and methods It is a prospective descriptive cohort study done in a tertiary center in India for a planned total enrollment of 100 patients. Singleton pregnancies with chronic/gestational HTN between 28 to 37 weeks were enrolled.sFlt1/PlGF was measured in serum samples on Roche platform. The results were stratified as Screen negative, borderline positive or Screen positive as per the cut offs (Fig. 1). Patients with Screen negative results underwent conventional testing for maternal fetal wellbeing every 2 weeks along with testing of the sFlt1/PlGF ratio until 35 weeks gestation. Borderline positives underwent testing every week while patients with positive results underwent testing for maternal and fetal wellbeing twice weekly. Once tested positive, the ratio was not repeated. Beyond 37 weeks biweekly clinical surveillance was carried out in the screen negatives and a birth plan was given at 38 to 39 weeks. In the screen positives, the decision to deliver was to be based only on worsening clinical status. Results Data on 21 patients resulting in 54 samples was analysed. Results were compared to 21 contemporaneous pregnancies with HTN from previous years before the use of sFlt1/PlGF ratio. Use of sFlt1/PlGF ratio for monitoring resulted in reduction of deliveries less than 30 weeks, increase in deliveries beyond 37 weeks, delayed delivery in patients with fetal growth restriction resulting in reduction in neonatal intensive care unit stay. There were no cases of perinatal death, eclampsia or maternal death (Fig. 2). Conclusion Clinical extrapolation of sFlt1/PlGF values in hypertensive pregnancies may help prolong stable pregnancies beyond 37 weeks without increase in perinatal mortality. Larger studies need to be done to confirm these findings.