Predelivery placenta-associated biomarkers and computerized intrapartum fetal heart rate patterns

Area of Science:

• Maternal-fetal medicine
• Obstetrics
• Biomarker research

Background:

• Syncytiotrophoblast stress in late pregnancy is associated with antiangiogenic dysregulation.
• Low placental growth factor (PlGF) and high soluble fms-like tyrosine kinase-1 (sFlt-1) indicate placental stress.
• Current cardiotocography is insufficient for predicting adverse neonatal outcomes.

Purpose of the Study:

• To assess if predelivery angiogenic protein concentrations correlate with intrapartum fetal heart rate patterns using the Oxford System (OxSys).
• To investigate the association between maternal angiogenic biomarkers and automated alerts in pregnancies with and without adverse neonatal outcomes.

Main Methods:

• Observational prospective cohort study of 956 singleton pregnancies (≥37 weeks gestation).
• Measured predelivery PlGF and sFlt-1 concentrations and analyzed intrapartum cardiotocography using OxSys 1.7.
• Outcomes categorized as 'complicated' or 'uncomplicated' based on adverse neonatal events.

Main Results:

• Lower mean PlGF was observed in pregnancies with OxSys 1.7 alerts (151 vs 169 pg/mL, P=.04).
• Weak negative correlations found between high sFlt-1/sFlt-1:PlGF ratio and low short-term variation.
• Decelerative capacity alerts increased more rapidly with decreasing PlGF in complicated pregnancies.

Conclusions:

• Automated alerts from OxSys 1.7 were more frequent in pregnancies with low maternal PlGF, indicating increased placental stress.
• An antiangiogenic profile (low PlGF) accelerated alert rates in pregnancies with adverse neonatal outcomes.
• Predelivery maternal PlGF measurements should be considered for future fetal compromise prediction tools.