Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Pregnancy Hypertens. 2021 Aug;25:123-128. doi: 10.1016/j.preghy.2021.05.023. Epub 2021 Jun 6.
Placental growth factor (PlGF) has shown promise in identification of placental fetal growth restriction (FGR). We aimed to investigate the association between PlGF and sonographic markers of placental dysfunction and assess its ability to diagnose FGR secondary to maternal vascular malperfusion (MVM).
A retrospective study of singleton pregnancies with small for gestational age (SGA) fetuses, who had PlGF testing at 16-36 weeks. Fetuses with major chromosomal and/or structural anomalies and pregnancies with missing outcomes were excluded. Sonographic characteristics, perinatal outcomes and placental histopathology were compared between pregnancies with normal and low PlGF (<10th percentile for gestational age). The diagnostic accuracy of PlGF for prediction of MVM was calculated.
130 fetuses met inclusion criteria. Compared to normal PlGF (n = 65), pregnancies with low PlGF (n = 65) were associated with an estimated fetal weight < 5th centile (73.8% (48) vs 53% (35), respectively, p = 0.01), abnormal uterine, umbilical and MCA Dopplers (p = 0.001 for all), fetal demise (18.8% (12) vs 0% respectively, p = 0.01) and preterm delivery (100% (65) vs 39% (59), respectively, p < 0.001) . Low PlGF had a 70.1% (58.6-80.0) sensitivity and a 79.6% (64.7-90.2) specificity for identifying MVM, with an AUC of 0.73 (0.63-0.84). Positive and negative predictive values were 85.7% (76.8-91.2) and 60.3% (51.2-68.9), respectively. PlGF outperformed other parameters of placental FGR (uterine, umbilical artery, middle cerebral artery and abdominal circumference < 5th centile), in isolation and when combined.
PlGF is a useful tool to aid in the diagnosis of placental FGR secondary to MVM.
胎盘生长因子（PlGF）在识别胎盘胎儿生长受限（FGR）方面显示出了潜力。我们旨在研究 PlGF 与胎盘功能障碍的超声标志物之间的关联，并评估其诊断因母体血管功能不全（MVM）导致的 FGR 的能力。
对 16-36 周接受 PlGF 检测的小胎龄（SGA）胎儿的单胎妊娠进行回顾性研究。排除有主要染色体和/或结构异常的胎儿以及有失访的妊娠。比较 PlGF 正常（<同胎龄第 10 百分位）和低值（<同胎龄第 10 百分位）妊娠的超声特征、围产儿结局和胎盘组织病理学。计算 PlGF 预测 MVM 的诊断准确性。
130 例胎儿符合纳入标准。与 PlGF 正常（n=65）相比，低值 PlGF（n=65）的胎儿估计体重<第 5 百分位（分别为 73.8%（48）和 53%（35），p=0.01），子宫、脐带和 MCA 多普勒异常（p=0.001 所有），胎儿死亡（18.8%（12）和 0%（0），p=0.01）和早产（100%（65）和 39%（59），p<0.001）。低值 PlGF 对识别 MVM 的敏感性为 70.1%（58.6-80.0），特异性为 79.6%（64.7-90.2），AUC 为 0.73（0.63-0.84）。阳性和阴性预测值分别为 85.7%（76.8-91.2）和 60.3%（51.2-68.9）。PlGF 在单独使用和联合使用时，优于其他胎盘 FGR （子宫、脐动脉、大脑中动脉和腹围<第 5 百分位）的参数。
PlGF 是一种有用的工具，可辅助诊断因 MVM 导致的胎盘 FGR。
