Lubis Muara Panusunan, Hariman Herman, Lumbanraja Sarma N, Bachtiar Adang
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia.
Open Access Maced J Med Sci. 2019 Apr 14;7(7):1153-1159. doi: 10.3889/oamjms.2019.154. eCollection 2019 Apr 15.
Reducing maternal mortality is one of the targets in the Millennium Development Goals (MDGs). In a systematic review, 4.6 per cent (95% CI 2.7-8.2) of pregnancies were complicated by preeclampsia worldwide. Preeclampsia occurs in around 10% of pregnancies in the world whereas developing countries contribute more than developed countries. In developing countries, there are 13 cases of preeclampsia in every 1,000 births, whereas in developed countries only 2-3 cases of preeclampsia are found in every 10,000 deliveries. Variations in prevalence among countries reflect, at least in part, differences in the distribution of maternal age and the proportion of nulliparous pregnant women in the population.
We aimed to investigate the role of placental growth factor, soluble endoglin, and uterine artery diastolic notch to predict the early onset of preeclampsia.
This study used an analytical study with a nested case-control design. The study was conducted at Bunda Thamrin Hospital, Tanjung Mulia Mitra Medika Hospital, Sundari Hospital and a private clinic, from March to November 2018 with a total sample of 70 research subjects.
Uterine artery diastolic notch was not found in 50% of subjects. A total of 27 subjects (38.6%) had a unilateral diastolic notch, and 8 subjects (11.4%) had a bilateral diastolic notch. Cut-off point PIGF levels was 441 pg/ml, and Area Under Curve (AUC) 82.5% (95% CI 61.5%-100%), with sensitivity 80% and specificity 87.7%. The levels sEng in this study could not predict the incidence of early-onset preeclampsia (p = 0.113). Combined PlGF and pulsatile index of uterine arteries may predict early onset preeclampsia with sensitivity 40% and specificity 90.77%. From these results, pregnant women o 22-24 weeks of pregnancy, the levels of PlGF and the uterine artery pulsatility index can be a predictor of early-onset preeclampsia. Examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia.
From these results, it can be concluded that in pregnant women of 22-24 weeks, the diastolic notches in uterine arteries cannot predict the incidence of early-onset preeclampsia. PlGF levels and pulsatile index of uterine arteries can be used as predictors of early-onset preeclampsia although examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia.
降低孕产妇死亡率是千年发展目标（MDGs）之一。在一项系统评价中，全球4.6%（95%置信区间2.7 - 8.2）的妊娠合并子痫前期。子痫前期在全球约10%的妊娠中发生，而发展中国家的病例数比发达国家更多。在发展中国家，每1000例分娩中有13例子痫前期病例，而在发达国家，每10000例分娩中仅发现2 - 3例子痫前期病例。各国患病率的差异至少部分反映了孕产妇年龄分布以及人群中初产妇比例的不同。
我们旨在研究胎盘生长因子、可溶性内皮糖蛋白和子宫动脉舒张期切迹在预测子痫前期早发中的作用。
本研究采用嵌套病例对照设计的分析性研究。该研究于2018年3月至11月在坦林布达医院、丹戎穆利亚米特拉医疗医院、桑达里医院和一家私人诊所进行，共70名研究对象。
50%的研究对象未发现子宫动脉舒张期切迹。共有27名研究对象（38.6%）有单侧舒张期切迹，8名研究对象（11.4%）有双侧舒张期切迹。胎盘生长因子（PIGF）水平的截断点为441 pg/ml，曲线下面积（AUC）为82.5%（95%置信区间61.5% - 100%），敏感性为80%，特异性为87.7%。本研究中可溶性内皮糖蛋白（sEng）水平无法预测子痫前期早发的发生率（p = 0.113）。联合胎盘生长因子和子宫动脉搏动指数可预测子痫前期早发，敏感性为为40%，特异性为90.77%。根据这些结果，妊娠22 - 24周的孕妇，胎盘生长因子水平和子宫动脉搏动指数可作为子痫前期早发的预测指标。单独检测胎盘生长因子水平就足以作为子痫前期早发的预测指标。
根据这些结果，可以得出结论，在妊娠22 - 24周的孕妇中，子宫动脉舒张期切迹无法预测子痫前期早发的发生率。胎盘生长因子水平和子宫动脉搏动指数可作为子痫前期早发的预测指标，尽管单独检测胎盘生长因子水平就足以作为子痫前期早发的预测指标。
