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01-06-2019 | Pre-Eclampsia | Maternal-Fetal Medicine

Pilot study: placental biomarker predictive capability (sFlt-1, PlGF and their ratio) of postpartum maternal outcome

Authors: Amr Hamza, Ch. Gerlinger, J. Radosa, E. F. Solomayer, J. Hagmann, U. Sester, R. Bohle, R. Stroeder, Z. Takacs, G. Meyberg-Solomayer, I. Juhasz-Boess, M. Kasoha

Published in: Archives of Gynecology and Obstetrics | Issue 6/2019

Abstract

Background

Prenatal measurement of placental biomarkers was able to improve screening and diagnosis of preeclampsia. Little is known about the clinical role of placental biomarkers in the postpartum period.

Methods

This study is a prospective monocentric trial that included a total of 30 women with preeclamptic pregnancies. Serum placental biomarkers including soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF) were measured before and 2 h after delivery by Enzyme-Linked Immunosorbent Assay (ELISA) using commercially available kits according to manufacturer’s instructions and correlated with the postpartum outcome.

Results

Postpartum higher serum PlGF level was associated with postpartum elevation of the systolic blood pressure. Yet, the placental biomarkers were not able to predict general worsening of postpartum preeclampsia or other individual clinical or laboratory parameters.

Conclusion

Serum concentrations of sFlt-1 and PlGF or their ratio in our study cohort did not completely predict the occurrence of postpartum preeclampsia. Yet, postpartum higher serum PlGF level was associated with postpartum elevation of the systolic blood pressure.

Hirashima C, Ohkuchi A, Arai F et al (2005) Establishing reference values for both total soluble Fms-like tyrosine kinase 1 and free placental growth factor in pregnant women. Hypertens Res Off J Jpn Soc Hypertens 28(9):727–732CrossRef

Barleon B, Sozzani S, Zhou D, Weich HA, Mantovani A, Marme D (1996) Migration of human monocytes in response to vascular endothelial growth factor (VEGF) is mediated via the VEGF receptor flt-1. Blood 87(8):3336–3343PubMed

Chaiworapongsa T, Romero R, Espinoza J et al (2004) Evidence supporting a role for blockade of the vascular endothelial growth factor system in the pathophysiology of preeclampsia: Young Investigator Award. Am J Obstetr Gynecol 190(6):1541–1547 (discussion 7–50) CrossRef

Levine RJ, Maynard SE, Qian C et al (2004) Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 350(7):672–683CrossRefPubMed

Salahuddin S, Lee Y, Vadnais M, Sachs BP, Karumanchi SA, Lim KH (2007) Diagnostic utility of soluble fms-like tyrosine kinase 1 and soluble endoglin in hypertensive diseases of pregnancy. Am J Obstet Gynecol 197(1):28.e1–28.e6CrossRef

Maglione D, Guerriero V, Viglietto G, Delli-Bovi P, Persico MG (1991) Isolation of a human placenta cDNA coding for a protein related to the vascular permeability factor. Proc Natl Acad Sci USA 88(20):9267–9271CrossRefPubMed

Verlohren S, Herraiz I, Lapaire O et al (2012) The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 206(1):58.e1–58.e8CrossRef

Herraiz I, Llurba E, Verlohren S, Galindo A (2018) Update on the diagnosis and prognosis of preeclampsia with the Aid of the sFlt-1/PlGF ratio in singleton pregnancies. Fetal Diagn Ther 43(2):81–89CrossRefPubMed

Stepan H, Hund M, Gencay M et al (2016) A comparison of the diagnostic utility of the sFlt-1/PlGF ratio versus PlGF alone for the detection of preeclampsia/HELLP syndrome. Hypertens Pregnancy 35(3):295–305CrossRefPubMedPubMedCentral

10.

Zeisler H, Llurba E, Chantraine F et al (2016) Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med 374(1):13–22CrossRefPubMed

11.

Zeisler H, Llurba E, Chantraine F et al (2016) Soluble fms-like tyrosine kinase-1-to-placental growth factor ratio and time to delivery in women with suspected preeclampsia. Obstet Gynecol 128(2):261–269CrossRefPubMed

12.

Zeisler H, Hund M, Verlohren S (2016) The sFlt-1:PlGF ratio in women with suspected preeclampsia. N Engl J Med 374(18):1785–1786CrossRefPubMed

13.

Droge L, Herraiz I, Zeisler H et al (2015) Maternal serum sFlt-1/PlGF ratio in twin pregnancies with and without pre-eclampsia in comparison with singleton pregnancies. Ultrasound Obstetr Gynecol 45(3):286–293CrossRef

14.

Stepan H, Herraiz I, Schlembach D et al (2015) Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstetr Gynecol 45(3):241–246CrossRef

15.

Herraiz I, Droge LA, Gomez-Montes E, Henrich W, Galindo A, Verlohren S (2014) Characterization of the soluble fms-like tyrosine kinase-1 to placental growth factor ratio in pregnancies complicated by fetal growth restriction. Obstet Gynecol 124(2 Pt 1):265–273CrossRefPubMed

16.

Verlohren S, Herraiz I, Lapaire O et al (2014) New gestational phase-specific cutoff values for the use of the soluble fms-like tyrosine kinase-1/placental growth factor ratio as a diagnostic test for preeclampsia. Hypertension (Dallas, Tex: 1979) 63(2):346–352CrossRef

17.

Schoofs K, Grittner U, Engels T et al (2014) The importance of repeated measurements of the sFlt-1/PlGF ratio for the prediction of preeclampsia and intrauterine growth restriction. J Perinat Med 42(1):61–68CrossRefPubMed

18.

Engels T, Pape J, Schoofs K, Henrich W, Verlohren S (2013) Automated measurement of sFlt1, PlGF and sFlt1/PlGF ratio in differential diagnosis of hypertensive pregnancy disorders. Hypertens Pregnancy 32(4):459–473CrossRefPubMed

19.

Verlohren S, Stepan H, Dechend R (2012) Angiogenic growth factors in the diagnosis and prediction of pre-eclampsia. Clin Sci (London, England: 1979) 122(2):43–52CrossRef

20.

Verlohren S, Herraiz I, Lapaire O et al (2011) L13. The routine measurement of the sFlt1/PlGF ratio allows differential diagnosis of hypertensive pregnancy disorders and has prognostic potential in preeclamptic patients. Pregnancy Hypertens 1(3–4):245–246CrossRefPubMed

21.

Verlohren S, Galindo A, Schlembach D et al (2010) An automated method for the determination of the sFlt-1/PlGF ratio in the assessment of preeclampsia. Am J Obstetr Gynecol 202(2):161CrossRef

22.

Stepan H, Schaarschmidt W, Jank A, Verlohren S, Kratzsch J (2010) Use of angiogenic factors (sFlt-1/PlGF ratio) to confirm the diagnosis of preeclampsia in clinical routine: first experience. Z Geburtshilfe Neonatol 214(6):234–238CrossRefPubMed

23.

Nicolaides KH (2017) Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med 377(24):2400PubMed

24.

Saleh L, van den Meiracker AH, Geensen R et al (2018) Soluble fms-like tyrosine kinase-1 and placental growth factor kinetics during and after pregnancy in women with suspected or confirmed pre-eclampsia. Ultrasound Obstetr Gynecol 51(6):751–757CrossRef

25.

Kaleta T, Stock A, Panayotopoulos D et al (2016) Predictors of impaired postpartum renal function in women after preeclampsia: results of a prospective single center study. Dis Mark 2016:7861919

26.

Stepan H, Kuse-Fohl S, Klockenbusch W et al (2015) Diagnosis and treatment of hypertensive pregnancy disorders. Guideline of DGGG (S1-Level, AWMF Registry No. 015/018, December 2013). Geburtshilfe Frauenheilkunde 75(9):900–914CrossRef

27.

Sibai BM (2012) Etiology and management of postpartum hypertension-preeclampsia. Am J Obstet Gynecol 206(6):470–475CrossRefPubMed

28.

Voigt M, Fusch C, Olbertz D et al (2006) Analyse des neugeborenenkollektivs der bundesrepublik deutschland. Geburtshilfe Frauenheilkd 66(10):956–970CrossRef

29.

Noori M, Donald AE, Angelakopoulou A, Hingorani AD, Williams DJ (2010) Prospective study of placental angiogenic factors and maternal vascular function before and after preeclampsia and gestational hypertension. Circulation 122(5):478–487CrossRefPubMed

30.

Ragab A, Goda H, Raghib M, Barakat R, El-Samanoudy A, Badawy A (2013) Does immediate postpartum curettage of the endometrium accelerate recovery from preeclampsia–eclampsia? A randomized controlled trial. Arch Gynecol Obstet 288(5):1035–1038CrossRefPubMed

31.

Matsuo K, Kooshesh S, Dinc M, Sun CC, Kimura T, Baschat AA (2007) Late postpartum eclampsia: report of two cases managed by uterine curettage and review of the literature. Am J Perinatol 24(4):257–266CrossRefPubMed

32.

Alkan A, Tugrul S, Oral O, Uslu H, Kose D, Catakli FT (2006) Effects of postpartum uterine curettage on maternal well-being in severe preeclamptic patients. Clin Exp Obstet Gynecol 33(1):55–58PubMed

33.

Magann EF, Bass JD, Chauhan SP, Perry KG Jr, Morrison JC, Martin JN Jr (1994) Accelerated recovery from severe preeclampsia: uterine curettage versus nifedipine. J Soc Gynecol Investig 1(3):210–214CrossRefPubMed

34.

Magann EF, Martin JN Jr, Isaacs JD, Perry KG Jr, Martin RW, Meydrech EF (1993) Immediate postpartum curettage: accelerated recovery from severe preeclampsia. Obstet Gynecol 81(4):502–506PubMed

35.

Ossada V, Jank A, Stepan H (2016) The impact of uterine curettage postpartum on maternal sFlt-1 concentration. J Perinat Med 44(3):351–354CrossRefPubMed

36.

Mc Lean G, Reyes O, Velarde R (2017) Effects of postpartum uterine curettage in the recovery from preeclampsia/eclampsia. A randomized, controlled trial. Pregnancy Hypertens 10:64–69CrossRefPubMed

37.

Clark DE, Smith SK, He Y et al (1998) A vascular endothelial growth factor antagonist is produced by the human placenta and released into the maternal circulation. Biol Reprod 59(6):1540–1548CrossRefPubMed

38.

Cohen J, Vaiman D, Sibai BM, Haddad B (2015) Blood pressure changes during the first stage of labor and for the prediction of early postpartum preeclampsia: a prospective study. Eur J Obstet Gynecol Reprod Biol 184:103–107CrossRefPubMed

Title: Pilot study: placental biomarker predictive capability (sFlt-1, PlGF and their ratio) of postpartum maternal outcome
Authors: Amr Hamza
Ch. Gerlinger
J. Radosa
E. F. Solomayer
J. Hagmann
U. Sester
R. Bohle
R. Stroeder
Z. Takacs
G. Meyberg-Solomayer
I. Juhasz-Boess
M. Kasoha
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Pre-Eclampsia
Biomarkers
Published in: Archives of Gynecology and Obstetrics / Issue 6/2019
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-019-05128-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pilot study: placental biomarker predictive capability (sFlt-1, PlGF and their ratio) of postpartum maternal outcome

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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