Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine, 41, D. Soutsou Str, 11521, Athens, Greece.
Arch Gynecol Obstet. 2024 Jul;310(1):237-243. doi: 10.1007/s00404-023-07214-2. Epub 2023 Oct 14.
To explore the value of measuring maternal serum PLGF in the prediction of the outcome of small for gestational age fetuses (SGA).
Singleton pregnancies referred with suspicion of SGA in the third trimester were included if they had: no indication for nor signs of imminent delivery, fetal abdominal circumference (AC) at or below the 10th centile and/or estimated fetal weight (EFW) at or below the 10th centile and/or umbilical artery pulsatility index (Umb-PI) at or above the 90th centile for gestation. Women with pre-eclampsia at presentation were excluded. Maternal blood was drawn at the first (index) visit and analyzed retrospectively.
Fifty-one fetuses were examined. Multiple regression analysis showed that family history of microsomia, index EFW and PLGF were significant predictors of the birthweight centile; index femur length centile and PLGF were significant predictors of pre-eclampsia; PLGF and index systolic blood pressure were significant predictors of iatrogenic preterm delivery < 37 weeks, whereas PLGF and index EFW were significant predictors of birthweight ≤ 5th centile and admission to the neonatal intensive care unit. For all outcomes, the addition of maternal-fetal parameters did not improve the prediction compared to PLGF alone. Using a cutoff of 0.3 MoM for PLGF would identify 94.1% of the pregnancies with iatrogenic preterm delivery and/or intra-uterine death and all of the cases that developed pre-eclampsia, for a screen positive rate of 54.9%. Women with PLGF ≤ 0.3 MoM had a poor fetal/maternal outcome (iatrogenic preterm delivery, pre-eclampsia, intra-uterine death) in 61.5% of cases.
In pregnancies complicated by SGA, PLGF identifies a very high-risk group that may benefit from intense surveillance.
探讨测量母体血清 PLGF 在预测胎儿生长受限（SGA）结局中的价值。
纳入怀疑存在胎儿生长受限的单胎妊娠，如果符合以下条件：无分娩指征且无即将分娩的迹象、胎儿腹围（AC）处于第 10 百分位或以下和/或估计胎儿体重（EFW）处于第 10 百分位或以下和/或脐动脉搏动指数（Umb-PI）处于妊娠第 90 百分位或以上。排除初次就诊时即出现子痫前期的孕妇。首次就诊时采集孕妇血液并进行回顾性分析。
共检查了 51 例胎儿。多元回归分析显示，家族性矮小症史、指数 EFW 和 PLGF 是出生体重百分位数的显著预测因素；指数股骨长度百分位数和 PLGF 是子痫前期的显著预测因素；PLGF 和指数收缩压是医源性早产<37 周的显著预测因素，而 PLGF 和指数 EFW 是出生体重≤第 5 百分位数和入住新生儿重症监护病房的显著预测因素。对于所有结局，与单独使用 PLGF 相比，添加母体-胎儿参数并不能改善预测。PLGF 的截断值为 0.3 MoM 可识别 94.1%的医源性早产和/或宫内死亡以及所有发生子痫前期的病例，阳性预测率为 54.9%。PLGF≤0.3 MoM 的孕妇有 61.5%的不良胎儿/母体结局（医源性早产、子痫前期、宫内死亡）。
在 SGA 合并妊娠中，PLGF 可识别出高危人群，这些人群可能受益于强化监测。
