Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine,, Emvryomitriki Fetal Medicine Unit, 41 D.Soutsou Str, 11521, Athens, Greece.
Arch Gynecol Obstet. 2024 Apr;309(4):1369-1376. doi: 10.1007/s00404-023-07012-w. Epub 2023 Mar 28.
To explore the contribution of maternal and fetal parameters in predicting the time interval between diagnosis and development of adverse events leading to delivery in singleton pregnancies complicated with fetal microsomia.
Prospective study on singleton pregnancies referred to a tertiary center because of suspicion of fetal smallness in the third trimester. The study cohort included cases with fetal abdominal circumference (AC) ≤ 10th centile or estimated fetal weight ≤ 10th centile or umbilical artery pulsatitlity index ≥ 90th centile. Development of pre-eclampsia, fetal demise, and fetal deterioration diagnosed by fetal Doppler studies or fetal heart rate monitoring and leading to delivery were considered as adverse events. Maternal demographics, obstetric history, blood pressure, serum PLGF, and fetal Doppler studies were explored as predictors of the time interval between the first visit to the clinic and the diagnosis of complications.
In 59 women, the median incubation period from presentation to the clinic to an adverse event was 6, 2 weeks, whereas half of the pregnancies (52.5%) did not develop any adverse event. PLGF was the strongest predictor of adverse events. Both PLGF in raw values and PLGF MOM had equally good predictive ability (AUC 0.82 and 0.78 respectively). Optimal cut-off points were 177.7 pg/ml for PLGF raw values (sensitivity 83% and specificity 66.7%) and 0.277 MoM (sensitivity 76% and specificity 86.7%). On multiple Cox regression analysis, maternal systolic blood pressure, PLGF, fetal increased umbilical artery PI, and reduced CP ratio were independently associated with adverse events. Half of the pregnancies with low PLGF and only one in ten with high PLGF were delivered within two weeks after the initial visit.
Half of the pregnancies carrying a small fetus in the third trimester will not develop maternal or fetal complications. PLGF is a strong predictor of adverse events that can be used to customize antenatal care.
探讨母体和胎儿参数在预测胎儿生长受限（fetalmicrosomia）单胎妊娠不良事件发生时间间隔中的作用。
对因怀疑胎儿生长受限而在妊娠晚期就诊的三级中心的单胎妊娠进行前瞻性研究。研究队列包括胎儿腹围（AC）≤第 10 百分位数或估计胎儿体重≤第 10 百分位数或脐动脉搏动指数（umbilicalarteryPulsatitlityindex）≥第 90 百分位数的病例。将子痫前期、胎儿死亡和胎儿多普勒研究或胎儿心率监测诊断的胎儿恶化发展并导致分娩视为不良事件。探讨母体人口统计学、产科史、血压、血清 PLGF 和胎儿多普勒研究作为首次就诊至并发症诊断时间间隔的预测因素。
在 59 名女性中，从就诊到出现不良事件的中位潜伏期为 6 周 2 天，而一半的妊娠（52.5%）未发生任何不良事件。PLGF 是不良事件的最强预测因子。PLGF 原始值和 PLGF MoM 均具有良好的预测能力（AUC 分别为 0.82 和 0.78）。最佳截断值分别为 PLGF 原始值 177.7pg/ml（敏感性 83%，特异性 66.7%）和 0.277 MoM（敏感性 76%，特异性 86.7%）。多因素 Cox 回归分析显示，母体收缩压、PLGF、胎儿脐动脉 PI 增加和 CP 比值降低与不良事件独立相关。PLGF 低值的妊娠中有一半在初始就诊后两周内分娩，而 PLGF 高值的妊娠中只有十分之一分娩。
三分之二的胎儿生长受限妊娠不会发生母体或胎儿并发症。PLGF 是不良事件的强有力预测因子，可用于定制产前护理。
