Second trimester angiotensing-converting enzyme and uterine artery Doppler as predictors of preeclampsia in a high-risk population.

OBJECTIVE: To investigate whether serum angiotensing-converting enzyme (ACE) and uterine artery Doppler (UAD) are useful markers as predictors of preeclampsia (PE) in a high-risk population. METHODS: Patients at risk of PE (n = 68) were subclassified as having PE (n = 8) or no PE (n = 60). Blood samples were obtained between 19 and 22 weeks of gestation. Doppler ultrasound of the uterine arteries was done at the time of blood sampling. Maternal serum ACE was determined through spectrophotometry assay (A15 Biosystem, ATOM, Barcelona, Spain). RESULTS: Comparing the group who presented PE with the one who was not developed it, we found significant differences for ACE (54.2 ± 21.2, 38.1 ± 12.3 U/L; p = 0.003); the pulsatility index (PI) (1.2 ± 0, 3.1 ± 0.3; p = 0.032) and resistance index (RI) (0.7 ± 0.1, 0.5 ± 0.1; p = 0.004). The AUC for ACE was 0.724, so we selected the cutoff of 36.5 U/L (sensitivity: 62.5% and specificity: 86.7%). The AUC for PI was 0.652 choosing a cutoff of 1.4 (sensitivity: 57.1% and specificity: 93.1%). The AUC for RI was 0.712 and the cutoff of 0.7 (sensitivity of 71.4% and specificity: 89.6%). The combination that allowed us to increase the diagnostic performance was the ACE+RI with Doppler study, increasing the AUC to 0.872. CONCLUSIONS: ACE, PI and RI as parameters of Doppler study were useful predictors of PE in the second trimester of gestation. The best combination to increase the diagnostic performance was ACE with the RI.

Placental growth factor, soluble fms-like tyrosine kinase 1 and progesterone as diagnostic biomarkers for ectopic pregnancy and missed abortion.

OBJECTIVE: The aim of this study is to investigate if progesterone, placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt1) serum levels are useful markers to differentiate between ectopic pregnancy (EP), missed abortion (MA) and viable intrauterine implantation pregnancy (IUP). METHODS: We designed a retrospective case-control study which included 100 pregnant women (50 EP and 50 MA) at 6-8 weeks of gestation with ßhCG serum levels between 800 and 3500 UI/L and a viable IUP group. Progesterone, PlGF and sFlt-1 levels were measured with an electrochemiluminescence assay (Roche Diagnostics, Manheim, Alemania). A non parametric test was used to compare the markers in the different groups and we used receiver operating characteristic (ROC) curve analysis to calculate the area under the curve (AUC). RESULTS: When we compared the EP group with the MA group, we didn't find significant differences for PlGF (15.1[13.2-17.4]/16.7[12.8-18.7] pg/mL) (p=0.275). We only obtained significant differences for progesterone (9.1[3.1-16.8]/2.6[1.3-6.1] ng/mL) (p<0.001) and sFlt-1 (84[65-96]/126[94-256] pg/mL) (p<0.001). The AUC for progesterone was 0.756 and the cutoff point with better sensitivity and lower false positive rate was 6 ng/mL (sensitivity=60%, specificity=72.7%). The AUC for sFlt-1 was 0.842 and the cutoff point was 93 pg/mL (sensitivity=84.5%, specificity=86.3%). The combination of both markers allowed us to increase the AUC to 0.910. CONCLUSIONS: In conclusion, the present study suggests that sFlt-1 could be a useful marker to differentiate between an EP or a MA when ßhCG levels are similar in both groups. The combination of sFlt-1 with progesterone helps to increase the diagnostic performance.