ABSTRACT
OBJECTIVES: The measurement of the soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio on automated platforms has improved the detection of preeclampsia and fetal growth restriction (PE/FGR). The cut-off points of >38 and ≥85 has been defined for "rule in" and "aid in diagnosis", respectively, using the Elecsys® platform. We aimed to compare the performance of these cut-offs between the Elecsys® and Kryptor platforms at 24-28 weeks. STUDY DESIGN: Observational case-control study of singleton pregnancies at high risk for PE/FGR and sFlt-1/PlGF measurement at 24-28 weeks' gestation: 21 cases (9 early PE/FGR with delivery <32 weeks) were 1:1 matched for body mass index and parity with 21 controls. Correlations of the sFlt-1, PlGF and sFlt-1/PlGF values and diagnostic accuracy of the >38 and ≥85 cutoffs for early and late PE/FGR using Elecsys® and Kryptor assays were evaluated. MAIN OUTCOME MEASURES: PE/FGR cases showed significantly higher median (IQR) sFlt-1/PlGF values at 24-28 weeks vs. controls, using both Elecsys® and Kryptor platforms: 55 (13-254) and 97 (13-530) vs. 4.1 (2.0-6.5) and 3.9 (1.8-7.7), respectively. The sFlt-1/PlGF correlation between both methods was excellent (r2 = 0.95) although lower PlGF and higher sFlt-1/PlGF values were observed with Kryptor. The higher diagnostic accuracy was obtained for early PE/FGR with the ≥85 cutoff (95.2%; 95%CI: 83.8-99.4%) in both platforms. CONCLUSION: sFlt-1/PlGF measurements correlates well between Elecsys® and Kryptor platforms, and the cutoffs of >38 and ≥85 exhibit high diagnostic accuracy for assessing early PE/FGR at 24-28 weeks with both methods.
Subject(s)
Fetal Growth Retardation/diagnosis , Immunoassay , Placenta Growth Factor/blood , Pre-Eclampsia/diagnosis , Vascular Endothelial Growth Factor Receptor-1/blood , Adult , Biomarkers/blood , Case-Control Studies , Early Diagnosis , Female , Fetal Growth Retardation/blood , Gestational Age , Humans , Pre-Eclampsia/blood , Predictive Value of Tests , Pregnancy , Reproducibility of ResultsABSTRACT
OBJECTIVE: The aim of this work was to identify independent risk factors influencing the achievement of vaginal delivery among women undergoing labor induction for late-onset fetal growth restriction (FGR). METHODS: This was a retrospective cohort study of 201 singleton pregnancies with late-onset FGR (diagnosed >32 + 0 weeks) that required labor induction with cervical ripening from 37 + 0 weeks, either with dinoprostone (from 2014 to 2015) or Foley balloon (from 2016 to 2018). Independent factors for successful vaginal delivery were identified. A prediction model of vaginal delivery with the identified factors was made using logistic regression and bootstrapping with 1,000 re-samples performed for bias correction. RESULTS: Perinatal results were more favorable in the vaginal delivery group, with significantly lower neonatal admission rates (4.0 vs. 13.7%) and lower composite neonatal morbidity (4.0 vs. 15.7%). The labor induction method (Foley balloon), higher cerebro-placental ratio, lower pre-gestational BMI, and absence of pre-eclampsia were identified as independent factors associated to vaginal delivery. The area under the curve of the model was of 0.75 (95% CI 0.70-0.79). CONCLUSIONS: The use of a Foley balloon is the only modifiable risk factor to improve the chances of vaginal delivery when attempting induction of labor in singleton pregnancies with late-onset FGR.
Subject(s)
Cervical Ripening/physiology , Fetal Growth Retardation/diagnostic imaging , Labor, Induced/methods , Adult , Age of Onset , Cohort Studies , Female , Fetal Growth Retardation/physiopathology , Humans , Infant, Newborn , Pregnancy , Prognosis , Retrospective Studies , Ultrasonography, Prenatal/methodsABSTRACT
OBJECTIVE: To compare vaginal delivery rate and perinatal outcomes of fetuses with late-onset fetal growth restriction (FGR) undergoing labor induction, depending on the method for cervical ripening (dinoprostone vs. Foley balloon). MATERIAL AND METHODS: We conducted a retrospective cohort study of 148 consecutive singleton gestations diagnosed with stage I late-onset FGR and Bishop score < 7, in which labor induction was indicated at ≥37 + 0 weeks. Before January 2016, cervical ripening was achieved with 10 mg of vaginal dinoprostone (n = 77) and afterwards with Fo-ley balloon (n = 71). Logistic regression analysis was used to estimate the association between mode of delivery and induction method. RESULTS: Foley balloon had lower percentages of uterine tachysystole with fetal repercussion (4.2 vs. 16.9%, p = 0.01) and cesarean sections for suspected fetal distress (7.0 vs. 26.0%, p < 0.01) when compared to dino-prostone. Lower percentages of cesarean sections were found in the Foley balloon group (15.5 vs. 37.7%, p < 0.01). The odds ratio and adjusted odds ratio of cesarean section with dinoprostone were of 3.3 and 4.4, respectively. Perinatal mortality and severe morbidity were null in both groups. CONCLUSION: The use of Foley balloon resulted in a higher percentage of vaginal delivery compared to dinoprostone, with a favorable safety profile in both groups.
Subject(s)
Delivery, Obstetric/methods , Dinoprostone/therapeutic use , Fetal Growth Retardation , Labor, Induced/methods , Adult , Cervical Ripening/drug effects , Cesarean Section/statistics & numerical data , Female , Humans , Pregnancy , Pregnancy Outcome , Retrospective StudiesABSTRACT
OBJECTIVE: To compare perinatal outcomes on fetuses classified as stage I late-onset fetal growth restriction (FGR) depending on the estimated fetal weight (EFW) centile category and the fetal and maternal Doppler study. MATERIAL AND METHODS: Retrospective cohort study on 131 cases of stage I late-onset FGR (diagnosis ≥32+0 weeks), defined as: EFW < 3rd centile and normal Doppler (G1) or EFW < 10th centile and mean uterine artery pulsatility index (PI) > 95th centile (G2) or EFW < 10th centile and mild fetal Doppler alteration: umbilical artery PI > 95th centile, middle cerebral artery PI < 5th centile, or cerebroplacental ratio < 5th centile (G3). All groups were compared to their perinatal results. RESULTS: There were 37, 30, and 64 cases in G1, G2, and G3, respectively. G1 and G2 showed lower percentages of cesarean section when compared with G3 (18.4, 22.5, and 45.3% (p < 0.01), respectively), being attributable to an excess of cesarean sections for non-reassuring fetal status. These differences remained when definitive birth weight centile was above that considered to define FGR, being 5.9, 12.5, and 41.8% (p < 0.01), respectively. DISCUSSION: In stage I late-onset FGR fetuses, abnormal fetal Doppler is associated with a poorer tolerance to vaginal delivery, even when the birth weight is > 10th centile.
Subject(s)
Fetal Growth Retardation/diagnostic imaging , Ultrasonography, Doppler , Adult , Biometry , Female , Fetal Weight , Humans , Pregnancy , Pregnancy Outcome , Retrospective StudiesABSTRACT
PROBLEM: To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemorrhage (PPH) with a control population. METHODS: A prospective cohort study was conducted between May 2014 and May 2016 and included 435 pregnant women at term (38 weeks gestation) without any known risk factor and with normal labor. Multiples of median (MoM) were used to evaluate differences of the PP13 values between cases and controls. PP13 concentrations were adjusted for maternal and neonatal weight. Multivariable analysis was used to detect independent contribution of predictors of PPH. RESULTS: Fifteen had a major PPH >1000 mLs and represented the cases of the study. They were matched with 399 controls. Twenty-one patients who had a minor PPH (500-1000 mLs) were excluded. The mean observed rank in the PPH group was higher than that of controls (28.5 vs 13.5, P-value=.01). PP13 MoM values adjusted for maternal weight were higher than expected being 1.44±0.45 in PPH cases and 1.00±0.59 in controls (P-value .008). This difference was still significant even after adjustment for neonatal weight that represented a confounding variable. CONCLUSION: Higher PP13 levels are independently associated with major PPH >1000 mLs.
Subject(s)
Galectins/metabolism , Placenta/metabolism , Postpartum Hemorrhage/epidemiology , Pregnancy Proteins/metabolism , Pregnancy , Term Birth/metabolism , Adult , Cohort Studies , Female , Galectins/genetics , Gestational Age , Humans , Postpartum Hemorrhage/etiology , Pregnancy Outcome , Pregnancy Proteins/genetics , Prospective Studies , Term Birth/geneticsABSTRACT
OBJECTIVE: To examine the clinical implementation of chromosome-selective sequencing of cell-free DNA (cfDNA) in maternal blood and an algorithm that relies on the lower fetal fraction contribution of the 2 fetuses in the assessment of risk for trisomies in twin pregnancies. METHODS: Risk for trisomies 21, 18 and 13 by cfDNA testing were estimated in stored plasma samples obtained at 11-13 weeks' gestation from 207 pregnancies with known outcome and prospectively in 68 twin pregnancies undergoing screening at 10-13 weeks. RESULTS: Risk scores for trisomies were provided for 192 (92.8%) of stored plasma and for 63 (92.6%) of the prospective cases. In the retrospective study, 10 of 11 trisomic pregnancies were correctly identified with no false positive results. In the prospective study, 3 trisomic pregnancies were correctly identified with no false positive results. The median of the lower fetal fraction in the prospective study of twins was 7.4% (IQR range 5.9-10.0%), which was lower than in our previous study in singletons (median 10.0%, IQR 7.8-13.0%). CONCLUSIONS: cfDNA testing in twins is feasible but the reporting rate of results is lower than in singletons due to a lower fetal fraction.
Subject(s)
DNA/genetics , Maternal Serum Screening Tests/methods , Pregnancy Trimester, First/genetics , Pregnancy, Twin/genetics , Trisomy/genetics , Adult , Cell-Free System/physiology , Female , Humans , Middle Aged , Pregnancy , Prenatal Diagnosis/methods , Prospective Studies , Retrospective Studies , Risk AssessmentABSTRACT
OBJECTIVE: To investigate potential performance of cell-free DNA (cfDNA) testing in maternal blood in detecting fetal triploidy. METHODS: Plasma and buffy coat samples obtained at 11-13 weeks' gestation from singleton pregnancies with diandric triploidy (n=4), digynic triploidy (n=4), euploid fetuses (n=48) were sent to Natera, Inc. (San Carlos, Calif., USA) for cfDNA testing. Multiplex polymerase chain reaction amplification of cfDNA followed by sequencing of single nucleotide polymorphic loci covering chromosomes 13, 18, 21, X, and Y was performed. Sequencing data were analyzed using the NATUS algorithm which identifies copy number for each of the five chromosomes. RESULTS: cfDNA testing provided a result in 44 (91.7%) of the 48 euploid cases and correctly predicted the fetal sex and the presence of two copies each of chromosome 21, 18 and 13. In diandric triploidy, cfDNA testing identified multiple paternal haplotypes (indicating fetal trisomy 21, trisomy 18 and trisomy 13) suggesting the presence of either triploidy or dizygotic twins. In digynic triploidy the fetal fraction corrected for maternal weight and gestational age was below the 0.5th percentile. CONCLUSIONS: cfDNA testing by targeted sequencing and allelic ratio analysis of single nucleotide polymorphisms covering chromosomes 21, 18, 13, X, and Y can detect diandric triploidy and raise the suspicion of digynic triploidy.
Subject(s)
DNA/genetics , Maternal Serum Screening Tests/methods , Triploidy , Adult , Cell-Free System/physiology , Female , Fetal Diseases/diagnosis , Fetal Diseases/genetics , Humans , Male , Middle Aged , Pregnancy , Prenatal Diagnosis/methods , Young AdultABSTRACT
Estudio de tipo descriptivo, retrospectivo y longitudinal que intenta identificar puntos sobre los cuales se puedan desarrollar intervenciones de enfermería, con el propósito de mejorar el manejo farmacológico que tienen embarazadas anémicas diagnosticadas antes de las 21 semanas de gestación. Se siguió una cohorte de 39 embarazadas desde el momento en que se les diagnosticó anemia hasta el parto. Se analizaron en forma separada el grupo que se recuperó de aquel que no lo logró. Los resultados reflejan que en el grupo que se recuperó hubo una mayor proporción de embarazadas con sobre peso; el tipo de medicamento más usado por este grupo fue el hierro no recubierto; y en su tratamiento hubo un mayor porcentaje de continuidad en la indicación de la terapia por parte del profesional. En cambio en aquellas embarazadas que no se recuperaron se observó que no tuvo un reforzamiento de las indicaciones por parte del profesional que realiza el control maternal; el fármaco más utilizado fue el hierro recubierto; hubo un mayor procentaje de multíparas; y el método anticonceptivo de tipo intrauterino era más utilizado por este grupo. Se sugiere una vigilancia más estricta sobre la terapia farmacológica de la embarazada anémica y unificar criterios en relación a:- punto de corte para el diagnóstico de anemia (sea sobre la base de los valores de hemoglobina); - se recomienda que el fármaco de elección sea el Sulfato Ferroso y la evaluación de la terapia se realice en forma mensual. Las indicaciones de la terapia farmacológica entregadas por el profesional se deben realizar en cada control maternal y deben quedar registradas en la ficha clínica
