Materno-fetal outcome with PlGF above or below cutoff during second half of pregnancy in high-risk women

OBJECTIVE

To evaluate the materno-fetal outcome of high-risk women using placental growth factor (PlGF).

METHODS

This prospective cohort study was performed at a tertiary care hospital from September 2019 to April 2022. Women having clinically major or minor high risk factors of pre-eclampsia were included after consent. The placental growth factor (PlGF) was evaluated among high-risk women at 20-22, 28-30, and 34-36 weeks of gestation. They were followed throughout pregnancy until delivery. Materno-fetal outcome was evaluated based on PlGF levels at three different time points. The gestational age specific cutoff was derived. Those with levels below cutoff were taken as cases and those with values above cutoff were considered as controls. The odds of having complications if the PlGF was below cutoff were determined.

RESULTS

Out of 287 high-risk women, 46 (16%) had pre-eclampsia (PE). The derived cutoff of PlGF was 224, 211, and 176 pg/mL at 20-22, 28-30, and 34-36 weeks, respectively. With PlGF below the cutoff at 20-22 weeks the odds of having HELLP syndrome was 15.8, with low PlGF at 28-30 weeks the odds for developing early onset PE was 11.3. Low PlGF was also significantly associated with preterm delivery (P < 0.001) and early onset FGR (P < 0.001). The sensitivity (91.7%) and specificity (78.5%) of PlGF for PE prediction was highest at 28-30 weeks.

CONCLUSION

Low PlGF at 28-30 weeks was associated with high likelihood of developing early onset PE, and the PlGF cutoff should be gestational age specific.

Antenatal risk stratification for preeclampsia with sFlt-1/PlGF ratio: Which is the best time to test?

OBJECTIVE

To find out the predictive value of sFlt-1/PlGF ratio for antenatal risk stratification (ARS) of women at high risk of preeclampsia (PE).

METHODS

Antenatal women at high risk of PE underwent sFlt-1/PlGF ratio at 20-22, 28-30 and 34-36 weeks and were followed till delivery. Those who developed PE were cases those who had normal outcome were controls, the cases and controls were compared.

RESULTS

Hypertension in pregnancy was seen in 116/287 (40.4 %), 46/287(16.0 %) had PE and 21(7.3 %) had early onset PE. Mean arterial pressure at 20-22 weeks was the high in those who developed early onset PE (109.08 ± 9.74 mmHg). The sFlt-1/PlGF ratio of 38 or more at 20-22 weeks resulted in either PE or adverse fetal outcome in all cases. Whereas, the ratio of less than 38 ruled out PE in all cases up to 29 + 6 weeks. At 28-30 weeks, the ratio less than 38 predicted no PE up to 34 weeks and no complication up to 29+6 weeks. The sensitivity for the detection at later gestation further decreased as the gestation advanced however the specificity was above 98 % at all gestations. The positive predictive value of the test increased with the advancing gestation, the negative predictive value was 93 % or higher at all gestations.

CONCLUSION

The usefulness of sFlt-1/PlGF ratio ≥38 for risk stratification was validated in the study, the testing at 28-30 weeks appeared to be the best time to test for PE prediction in high risk women.

Ultrasound placental image texture analysis using artificial intelligence to predict hypertension in pregnancy

BACKGROUND

The placental pathological changes in hypertensive disorders of pregnancy (HDP) starts early in pregnancy, the deep convolutional neural networks (CNN) can identify these changes before its clinical manifestation.

OBJECTIVE

To compare the placental quantitative ultrasound image texture of women with HDP to those with the normal outcome.

METHODS

The cases were enrolled in the first trimester of pregnancy, good quality images of the placenta were taken serially in the first, second, and third trimester of pregnancy. The women were followed till delivery, those with normal outcomes were controls, and those with HDP were cases. The images were processed and classified using validated deep learning tools.

RESULTS

Total of 429 cases were fully followed till delivery, 58 of them had HDP (13.5%). In the first trimester, there was a significant difference in the placental length (p = .033), uterine artery PI (p = .019), biomarkers PAPP-A (p = .001) PlGF (p = .013) and placental image texture (p = .001) between the cases and controls. In the second trimester the uterine artery PI, serum PAPP-A (p = .010) and PlGF (p = .005) levels were significantly low among women who developed hypertension later on pregnancy. The image texture disparity between the two groups was highly significant (p < .001). The model "resnext 101_32x8d" had Cohen kappa score of 0.413 (moderate) and the accuracy score of 0.710 (good). In the first trimester the best sensitivity and specificity was observed for abnormal placental image texture (70.6% and 76.6%, respectively) followed by PlGF (64% and 50%, respectively), in the second trimester the abnormal image texture had the highest sensitivity and specificity (60.4% and 73.3%, respectively) followed by uterine artery PI (58.6% and 54.7%, respectively). Similarly in the third trimester, uterine artery PI had sensitivity and specificity of 60.3% and specificity of 50.7%, whereas the abnormal image texture had sensitivity and specificity of 83.5%.

CONCLUSION

Ultrasound placental analysis using artificial intelligence (UPAAI) is a promising technique, would open avenues for more research in this field.

Prediction of hypertension in pregnancy in high risk women using maternal factors and serial placental profile in second and third trimester

INTRODUCTION

To evaluate the role of placental profile markers in second and third trimester of pregnancy in predicting hypertensive disorders of pregnancy (HDP) in women at high risk of preeclampsia.

METHOD

Women who were at high risk of preeclampsia underwent βhCG, ultrasound assessment of placental length, thickness and its ratio, uterine artery Doppler at 20-24 weeks and 28-32 weeks of gestation, the outcome at delivery was noted. Those who developed HDP were cases and those with normal outcome were controls. The placental profile markers among cases and controls were compared.

RESULTS

Hypertensive disorders of pregnancy was seen in 72/160 (45%) high risk women The serum β hCG levels at 20-24 weeks (p = 0.001) and 28-32 weeks (p = 0.018) was significantly high in women who had preeclampsia. Placental thickness was found to be less in among all subgroups of HDP, for preeclampsia, it was significantly low at 20-24 weeks (AUC- 0.743; sensitivity- 75%, specificity- 66.3%) and 28 weeks (AUC -0.764, sensitivity - 75.0% specificity - 78.7%). Uterine artery S/D ratio was considerable high in women with chronic hypertension (AUC -0.765), gestational hypertension (AUC -0.771) and preeclampsia (AUC -0.726) at 20-24 weeks. In preeclampsia group, uterine artery PI was highest and the best marker at 20-24 weeks (AUC -0.935, sensitivity - 100.0%, specificity - 87.6%).

DISCUSSION

The placental profile markers may be used to provide closer follow up in high risk pregnancies with abnormal placental profile levels, while less intense follow up in those with normal levels, thus channelizing the resources.

Oxidative Stress is Independent Factor for End-stage Renal Disease in Type 2 Diabetes Mellitus Patients

An imbalance between oxidant and antioxidants is thought to precede the development of renal lesions. The aim of present study is to determine the relationship between oxidative markers and severity of microalbuminuria in patients with type 2 diabetes mellitus (T2DM). A total of 100 T2DM patients (50 males and 50 females) participated in this study. They were screened for microalbuminuria along with oxidative status in patients. Microalbuminuria was detected by measuring the albumin to creatinine ratio (ACR) in urine samples. Patients were divided into two groups; normoalbuminuria (n=36) and microalbuminuria (n=64) as per the ACR levels. No difference in the groups was observed in terms of age, sex, glycated hemoglobin (HbA1c) and blood pressure. The level of oxidative stress was significantly higher in microalbuminuria group of T2DM patients. A significant correlation was observed between ACR and lipid peroxidation (MDA) levels. We conclude that oxidative stress is one of the important mediators of end-stage renal disease (ESRD).