Is a sFlt-1/PlGF cutoff of 38 suitable to predict adverse outcomes in pregnancies with abnormal uterine artery Doppler velocimetry in the second trimester?

OBJECTIVE

To determine the optimal cutoff value for the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio to predict maternal and fetal adverse events in pregnancies with uterine artery Doppler scans results above the 95th percentile in the late second trimester.

STUDY DESIGN

Retrospective, observational cohort study on 116 asyntomatic patients with abnormal uterine artery Doppler scans at gestational week 25. The sFlt-1/PlGF ratio was determined within the weeks 25 to 29 of gestation and ROC curve analysis performed. The diagnostic validity of different cutoff values to predict severe maternal and fetal complications, i.e. preeclampsia, fetal growth restriction, placental abruption, and fetal death, was analyzed.

MAIN OUTCOME MEASURES

An ideal cutoff for sFlt-1/PlGF ratios in pregnancies with abnormal uterine artery Doppler in the second trimester.

RESULTS

Applying a cutoff point of 38, the area under the ROC curve was 0.89, generally considered low risk in fetal and maternal complication prediction. The sensitivity was 32.1%, the specificity 98.4%, the positive predictive value (PPV) 94.4%, and the negative predictive value (NPV) 63.3%. A cutoff value of 10, leading to the highest Youden index, performed best at detecting overall complications, increasing sensitivity to 69.8% and the NPV to 76.8%. at the cost of a reduced specificity and PPV.

CONCLUSIONS

In pregnancies with abnormal uterine artery Doppler in the second trimester, an sFlt-1/PlGF cutoff value greater than equal to 38 improves its predictive power for adverse events.

Norepinephrine, epinephrine and MHPG levels in chick brain development

In this study we determined the norepinephrine (NE), epinephrine and methoxy-hydroxy-phenyl-glycol (MHPG) levels in dissected chick telencephalon, diencephalon/mesencephalon and cerebellum in a number of stages from the late embryonic period (E16, E17, E18 and E19) and post-hatching period (P1, P2, P3, P4, P5, P15 and P30) using HPLC coupled with a coulometric detection system. A mobile phase which permits the detection of NE, epinephrine and MHPG simultaneously is also described. During development, NE levels increase dramatically after hatching in all brain structures studied and are not correlated in the same period with an increase in the MHPG/NE ratio. The values obtained for epinephrine and MHPG were significantly lower than the NE values in all the structures and stages studied. Our results support the notion of a specific role for NE during the first days after hatching.