Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/135099
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Type: Journal article
Title: Role of placental, fetal and cardiovascular markers in predicting adverse outcomes in women with suspected or confirmed pre-eclampsia
Author: Reddy, M.
Palmer, K.
Rolnik, D.L.
Wallace, E.M.
Mol, B.W.
Da Silva Costa, F.
Citation: Ultrasound in Obstetrics and Gynecology, 2022; 59(5):596-605
Publisher: Wiley
Issue Date: 2022
ISSN: 0960-7692
1469-0705
Statement of
Responsibility: 
M. Reddy, K. Palmer, D. L. Rolnik, E. M. Wallace, B. W. Mol, F. Da Silva Costa
Abstract: Objective: To assess the performance of placental, fetal and maternal cardiovascular markers in the prediction of adverse perinatal and maternal outcomes in women with suspected or confirmed pre-eclampsia. Methods: This was a prospective prognostic accuracy study of women with suspected or confirmed pre-eclampsia who underwent a series of investigations to measure maternal hemodynamic indices, mean arterial pressure, augmentation index, ophthalmic artery peak systolic velocity (PSV) ratio, uterine artery pulsatility index (UtA-PI), fetal biometric and Doppler parameters, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). The performance of these markers, individually or in combination, in predicting adverse perinatal and maternal outcomes was then assessed using receiver-operating-characteristics (ROC)-curve analysis. Adverse maternal outcome was defined as one or more of severe hypertension, admission to the intensive care unit, eclampsia, placental abruption, HELLP syndrome, disseminated intravascular coagulation, platelets < 100 × 109/L, creatinine > 90μmol/L and alanine aminotransferase > 100 U/L. Adverse perinatal outcome was defined as one or more of preterm birth at or before 34 + 0 weeks, neonatal intensive care unit admission for > 48 h, respiratory distress syndrome, intraventricular hemorrhage, hypoxic ischemic encephalopathy, necrotizing enterocolitis, retinopathy of prematurity and confirmed fetal infection. Results: We recruited 126 women with suspected (n = 31) or confirmed (n = 95) pre-eclampsia at a median gestational age of 33.9 weeks (interquartile range, 30.9–36.3 weeks). Pregnancies with adverse perinatal outcome compared to those without had a higher median UtA-PI (1.3 vs 0.8; P < 0.001), ophthalmic artery PSV ratio (0.8 vs 0.7; P = 0.01) and umbilical artery PI percentile (82.0 vs 68.5; P < 0.01) and lower median estimated fetal weight percentile (4.0 vs 43.0; P < 0.001), abdominal circumference percentile (4.0 vs 63.0; P < 0.001), middle cerebral artery PI percentile (28.0 vs 58.5; P < 0.001) and cerebroplacental ratio percentile (18.0 vs 46.5; P < 0.001). Pregnancies with adverse perinatal outcome also had a higher median sFlt-1 (8208.0 pg/mL vs 4508.0 pg/mL; P < 0.001), lower PlGF (27.2 pg/mL vs 76.3 pg/mL; P < 0.001) and a higher sFlt-1/PlGF ratio (445.4 vs 74.4; P < 0.001). The best performing individual marker for predicting adverse perinatal outcome was the sFlt-1/PlGF ratio (area under the ROC curve (AUC), 0.87 (95% CI, 0.81–0.93)), followed by estimated fetal weight (AUC, 0.81 (95% CI, 0.73–0.89)). Women who experienced adverse maternal outcome had a higher median sFlt-1 level (7471.0 pg/mL vs 5131.0 pg/mL; P < 0.001) and sFlt-1/PlGF ratio (204.3 vs 93.3; P < 0.001) and a lower PlGF level (37.0 pg/mL vs 66.1 pg/mL; P = 0.01) and estimated fetal weight percentile (16.5 vs 37.0; P = 0.04). All markers performed poorly in predicting adverse maternal outcome, with sFlt-1 (AUC, 0.69 (95% CI, 0.60–0.79)) and sFlt-1/PlGF ratio (AUC, 0.69 (95% CI, 0.59–0.78)) demonstrating the best individual performance. The addition of cardiovascular, fetal or other placental indices to the sFlt-1/PlGF ratio did not improve the prediction of adverse maternal or perinatal outcomes. Conclusions: The sFlt-1/PlGF ratio performs well in predicting adverse perinatal outcomes but is a poor predictor of adverse maternal outcomes in women with suspected or diagnosed pre-eclampsia. The addition of cardiovascular or fetal indices to the model is unlikely to improve the prognostic performance of the sFlt-1/PlGF ratio.
Keywords: adverse outcome; hemodynamics; ophthalmic artery; placental growth factor; pre-eclampsia; soluble fms-like tyrosine kinase-1; uterine artery
Rights: © 2022 International Society of Ultrasound in Obstetrics and Gynecology
DOI: 10.1002/uog.24851
Grant ID: http://purl.org/au-research/grants/nhmrc/GNT1151281
http://purl.org/au-research/grants/nhmrc/GNT1176437
Published version: http://dx.doi.org/10.1002/uog.24851
Appears in Collections:Obstetrics and Gynaecology publications

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