Placental Growth Factor-soluble FMS-like Tyrosine Kinase-1 Ratio in Placenta Accreta Spectrum Disorder: Case Control Study

Abstract

AIM: The aim of the study was to assess the ratio of placental growth factor (PLGF)/soluble FMSlike tyrosine kinase (sFLT-1) as a marker for in placenta accreta spectrum disorder stage. METHODS: We enrolled 50 participants in this study, 25 participants diagnosed with placenta accreta spectrum disorder and 25 participants with normal pregnancy as controls. Diagnosis is based on ultrasonographic criteria from the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) for spectrum disorders of placenta accreta. Up to 3 cc peripheral venous blood was taken before cesarean section to measured PLGF and sFlt-1 level by ELISA. All data then analyze using SPSS version 26. RESULTS: In this study, we found that the levels of sFlt-1 in the placenta accreta group (Placenta accreta spectrum stage 0/1/2) were 1711 (136.87) pg/ml, 1474 (122.88) pg/ml, and 1417 (125.45) pg/ml each. This level was higher than the control group of 1246 (98) pg/ml (p = 0.004). In measuring PLGF levels, we found that PLGF levels in the control group were lower than those in the placenta accreta group (PAS 0/1/2) with levels of 404 (33.12) pg/ml, 612 (48.96) pg/ml, 805 (53.48) pg/ml, and 785 (53.64) pg/ml, respectively. We found a correlation between placenta accreta spectrum staging with sFlt-1 levels (r = 0.27 and p = 0.015) and PLGF levels (r = 0.6646 and p = 0.001). Ratio of sFlt-1/PLGF with cutoff point 1.8 has sensitivity 97% and specificity 67% (Area under the curve (AUC) 0.784). CONCLUSIONS: There is a correlation between sFlt-1 and PLGF levels with placenta accreta staging based on PAS score. sFlt-1/PLGF ratio can be considered as a predictor of placenta accreta to help establish the diagnosis of placenta accreta.