Dr Dinithi Samarawickrama1, Dr Gary Low1,2, Dr Lucy Bowyer3,4
1Nepean Blue Mountains Local Health District, Kingswood, Australia, 2University of Sydney, Camperdown, Australia, 3Ultrasound Care Australia, Wahroonga, Australia, 4University of New South Wales, Kensington, Australia
Biography:
Dinithi is a prevocational doctor working in Obstetrics and Gynaecology in Greater Western Sydney. Her areas of interest include maternal-foetal medicine and migrant and refugee women's health.
Abstract:
Background: Low Placental Growth Factor (PlGF) is well described to be associated with adverse obstetric outcomes such as pre-eclampsia, low birthweight, and prematurity. PlGF is routinely measured in the first trimester to identify those at highest risk of pre-eclampsia. This study aims to identify the obstetric outcomes of those with very low PlGF levels (<0.2 MoM). This is a pilot study, so the secondary outcomes are to assess the feasibility of applying this study to a larger, full-scale study.
Methods: A retrospective cohort study was conducted within a database of patients from a chain of private ultrasound practices in Sydney. Data was initially collected from the medical record database, and patients with PlGF <0.2MoM were identified. Private obstetricians and GPs of these patients were then contacted to identify obstetric outcomes. Outcomes of interest include hypertensive complications, birthweight, gestational age at birth and stillbirth. Receiver Operating Characteristics (ROC) was used to evaluate the diagnostic accuracy of PlGF. Area under the curve (AUC) and its standard error was calculated. In addition, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the few optimal cut-off identified.
Results: A cohort of 3293 women were sampled, of which 32 had a PlGF level less than 0.2 MoM. Of these, 18 women (64%) were identified as having an adverse outcome such as intrauterine growth restriction, pre-eclampsia or still birth.
Conclusions: A PlGF level <0.2MoM is strongly correlated with adverse obstetric outcomes. This can be used to identify those at highest risk of adverse obstetric outcome, and so can enable closer monitoring and targeted allocation of resources.
Keywords
Placental Growth Factor, Obstetric Outcomes
References
Stepan, H., Galindo, A., Hund, M., Schlembach, D., Sillman, J., Surbek, D., & Vatish, M. (2023). Clinical utility of sFlt-1 and PLGF in screening, prediction, diagnosis and monitoring of pre-eclampsia and fetal growth restriction. Obstetrical & Gynecological Survey, 78(8), 451–453. https://doi.org/10.1097/ogx.0000000000001185
Huang, T., Rashid, S., Priston, M., Rasasakaram, E., Mak-Tam, E., Gibbons, C., Mei-Dan, E., & Bedford, H. M. (2023). Prenatal screening for preeclampsia: The roles of placental growth factor and pregnancy–associated plasma protein A in the first trimester and placental growth factor and soluble FMS-like tyrosine kinase 1–placental growth factor ratio in the early second trimester. AJOG Global Reports, 3(2), 100193. https://doi.org/10.1016/j.xagr.2023.100193
Ekelund CK, Rode L, Tabor A, Hyett J, McLennan A. Placental growth factor and adverse obstetric outcomes in a mixed-risk cohort of women screened for preeclampsia in the first trimester of pregnancy. Fetal Diagnosis and Therapy. 2021;48(4):304–12. doi:10.1159/000514201