Skip to main content
Top
Published in: Archives of Gynecology and Obstetrics 3/2018

01-09-2018 | Maternal-Fetal Medicine

sFlt-1/PlGF ratio for the prediction of the time of delivery

Authors: Oliver Graupner, Silvia M. Lobmaier, Javier U. Ortiz, Anne Karge, Bettina Kuschel

Published in: Archives of Gynecology and Obstetrics | Issue 3/2018

Login to get access

Abstract

Purpose

The soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio has been shown to be a useful parameter for the diagnosis and prediction of preeclampsia (PE). An increased sFlt-1/PlGF ratio can be closely linked to the need to deliver. The aim of the study was to examine the mean time until delivery (MTUD) in pregnant women with a strongly increased sFlt-1/PlGF ratio.

Methods

From 2010 to 2018, the sFlt-1/PlGF ratio was determined in 995 singleton pregnancies with diagnosis or suspicion of PE/HELLP syndrome and/or intrauterine growth restriction (IUGR). MTUD of patients with a value above 655 in < 34 weeks of gestation (group 1: n = 13) and above 201 in ≥ 34 weeks of gestation (group 2: n = 15) was calculated. Patients with a value > 85 but < 655 in < 34 weeks of gestation (group 3: n = 70) and a value > 110 but < 201 (group 4: n = 44) in ≥ 34 weeks of gestation acted as controls.

Results

28 pregnant women with severely elevated sFlt-1/PlGF ratio and 114 controls were included. In group 1, MTUD was longer compared to group 2 without reaching statistical significance (96.7 h ± 132.2 vs. 47.7 h ± 44, p = 0.222). In pregnancies < 34 weeks of gestation (early onset), MTUD was significantly longer in group 3 compared to group 1 (361 h ± 317.3 vs. 96.7 h ± 132.2, p < 0.001). In pregnancies ≥ 34 weeks of gestation (late onset), MTUD was significantly longer in group 4 compared to group 2 (123.6 h ± 139.2 vs. 47.7 h ± 44, p = 0.002).

Conclusions

The sFlt-1/PlGF ratio is suitable for decision-making regarding close monitoring of high-risk patients and need for lung maturation. However, for planning of delivery itself further prospective interventional studies are required to define its role as outcome predictor.
Literature
1.
go back to reference Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF et al (2004) Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 350(7):672–683CrossRefPubMed Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF et al (2004) Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 350(7):672–683CrossRefPubMed
2.
go back to reference Rana S, Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, Lim KH, Wenger JB, Thadhani R, Karumanchi SA (2012) Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation 125:911–919CrossRefPubMedPubMedCentral Rana S, Powe CE, Salahuddin S, Verlohren S, Perschel FH, Levine RJ, Lim KH, Wenger JB, Thadhani R, Karumanchi SA (2012) Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation 125:911–919CrossRefPubMedPubMedCentral
3.
go back to reference Verlohren S, Herraiz I, Lapaire O, Schlembach D, Moertl M, Zeisler H, Calda P, Holzgreve W, Galindo A, Engels T, Denk B, Stepan H. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 2012; 206:58.e1–8 Verlohren S, Herraiz I, Lapaire O, Schlembach D, Moertl M, Zeisler H, Calda P, Holzgreve W, Galindo A, Engels T, Denk B, Stepan H. The sFlt-1/PlGF ratio in different types of hypertensive pregnancy disorders and its prognostic potential in preeclamptic patients. Am J Obstet Gynecol 2012; 206:58.e1–8
4.
go back to reference Gomez-Arriaga PI, Herraiz I, Lopez-Jimenez EA, Escribano D, Denk B, Galindo A (2014) Uterine artery Doppler and sFlt-1/PlGF ratio: prognostic value in early-onset preeclampsia. Ultrasound Obstet Gynecol 43:525–532CrossRefPubMed Gomez-Arriaga PI, Herraiz I, Lopez-Jimenez EA, Escribano D, Denk B, Galindo A (2014) Uterine artery Doppler and sFlt-1/PlGF ratio: prognostic value in early-onset preeclampsia. Ultrasound Obstet Gynecol 43:525–532CrossRefPubMed
5.
go back to reference Schoofs K, Grittner U, Engels T, Pape J, Denk B, Henrich W, Verlohren S (2014) The importance of repeated measurements of the sFlt1/PLGF ratio for the prediction of preeclampsia and intrauterine growth restriction. J Perinat Med 42(1):61–68CrossRefPubMed Schoofs K, Grittner U, Engels T, Pape J, Denk B, Henrich W, Verlohren S (2014) The importance of repeated measurements of the sFlt1/PLGF ratio for the prediction of preeclampsia and intrauterine growth restriction. J Perinat Med 42(1):61–68CrossRefPubMed
6.
go back to reference Lobmaier SM, Figueras F, Mercade I, Perello M, Peguero A, Crovetto F, Ortiz JU, Crispi F, Gratacós E (2014) Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late-pregnancy small-for-gestational-age fetuses. Ultrasound Obstet Gynecol 43(5):533–540CrossRefPubMed Lobmaier SM, Figueras F, Mercade I, Perello M, Peguero A, Crovetto F, Ortiz JU, Crispi F, Gratacós E (2014) Angiogenic factors vs Doppler surveillance in the prediction of adverse outcome among late-pregnancy small-for-gestational-age fetuses. Ultrasound Obstet Gynecol 43(5):533–540CrossRefPubMed
7.
go back to reference ACOG Committee on Obstetric Practice (2002) ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Int J Gynaecol Obstet 77(1):67–75CrossRef ACOG Committee on Obstetric Practice (2002) ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Int J Gynaecol Obstet 77(1):67–75CrossRef
8.
go back to reference American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy (2013) Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 122(5):1122–1131CrossRef American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy (2013) Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 122(5):1122–1131CrossRef
10.
go back to reference Tranquilli AL, Brown MA, Zeeman GG, Dekker G, Sibai BM (2013) The definition of severe and earlyonset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Pregnancy Hypertens 3(3):44–47CrossRefPubMed Tranquilli AL, Brown MA, Zeeman GG, Dekker G, Sibai BM (2013) The definition of severe and earlyonset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Pregnancy Hypertens 3(3):44–47CrossRefPubMed
11.
go back to reference Weinstein L (1982) Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 142:159–167CrossRefPubMed Weinstein L (1982) Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 142:159–167CrossRefPubMed
12.
go back to reference Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, Silver RM, Wynia K, Ganzevoort W (2016) Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 48:333–339CrossRefPubMed Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, Silver RM, Wynia K, Ganzevoort W (2016) Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol 48:333–339CrossRefPubMed
13.
go back to reference Stepan H, Herraiz I, Schlembach D, Verlohren S, Brennecke S, Chantraine F, Klein E, Lapaire O, Llurba E, Ramoni A, Vatish M, Wertaschnigg D, Galindo A (2015) Implementation of the sFlt1/PlGF ratio for prediction and diagnosis of preeclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstet Gynecol 45:241–246CrossRefPubMedPubMedCentral Stepan H, Herraiz I, Schlembach D, Verlohren S, Brennecke S, Chantraine F, Klein E, Lapaire O, Llurba E, Ramoni A, Vatish M, Wertaschnigg D, Galindo A (2015) Implementation of the sFlt1/PlGF ratio for prediction and diagnosis of preeclampsia in singleton pregnancy: implications for clinical practice. Ultrasound Obstet Gynecol 45:241–246CrossRefPubMedPubMedCentral
14.
go back to reference Lees CC, Marlow N, van Wassenaer-Leemhuis A, Arabin B, Bilardo CM, Brezinka C, Calvert S, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KT, Thilaganathan B, Todros T, Valcamonico A, Visser GH, Wolf H, TRUFFLE study group (2015) 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet. 385(9983):2162–2172CrossRefPubMed Lees CC, Marlow N, van Wassenaer-Leemhuis A, Arabin B, Bilardo CM, Brezinka C, Calvert S, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KT, Thilaganathan B, Todros T, Valcamonico A, Visser GH, Wolf H, TRUFFLE study group (2015) 2 year neurodevelopmental and intermediate perinatal outcomes in infants with very preterm fetal growth restriction (TRUFFLE): a randomised trial. Lancet. 385(9983):2162–2172CrossRefPubMed
15.
go back to reference Klein E, Schlembach D, Ramoni A, Langer E, Bahlmann F, Grill S, Schaffenrath H, van der Does R, Messinger D, Verhagen-Kamerbeek WD, Reim M, Hund M, Stepan H (2016) Influence of the sFlt-1/PlGF Ratio on Clinical Decision-Making in Women with Suspected Preeclampsia. PLoS One 11(5):e0156013CrossRefPubMedPubMedCentral Klein E, Schlembach D, Ramoni A, Langer E, Bahlmann F, Grill S, Schaffenrath H, van der Does R, Messinger D, Verhagen-Kamerbeek WD, Reim M, Hund M, Stepan H (2016) Influence of the sFlt-1/PlGF Ratio on Clinical Decision-Making in Women with Suspected Preeclampsia. PLoS One 11(5):e0156013CrossRefPubMedPubMedCentral
16.
go back to reference Barton JR, Sibai BM (2017) Biomarkers for prediction, risk stratification, and ruling out preeclampsia: what are the appropriate goals and objectives? Am J Perinatol 34(4):415–418PubMed Barton JR, Sibai BM (2017) Biomarkers for prediction, risk stratification, and ruling out preeclampsia: what are the appropriate goals and objectives? Am J Perinatol 34(4):415–418PubMed
Metadata
Title
sFlt-1/PlGF ratio for the prediction of the time of delivery
Authors
Oliver Graupner
Silvia M. Lobmaier
Javier U. Ortiz
Anne Karge
Bettina Kuschel
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 3/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-018-4840-3

Other articles of this Issue 3/2018

Archives of Gynecology and Obstetrics 3/2018 Go to the issue