Placental biomarkers in prediction of perinatal death: A prospective study

The objective was to determine the predictive value of biomarkers placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT-1) and uterine artery pulsatility index (UtA-PI) in identifying pregnancies at high-risk of perinatal mortality (PM).

In this prospective cohort study, the levels of sFLT-1 and PlGF, along with UtA-PI, were assessed in 1008 antenatal women in each trimester of pregnancy. The perinatal fetal outcome at delivery was recorded. The maternal clinical and biochemical parameters were compared between cases with PM and those with live neonatal outcomes. Using the T-test for parametric, and Mann-Whitney test for non-parametric data.

PM occurred in 30/1008 (3.0%) cases, antepartum, intrapartum, and neonatal mortality accounted for 73%, 9.3%, 16.7% cases, respectively. Among the maternal characteristics, the presence of hypertensive disorders of pregnancy (HDP) was found to increase the likelihood ratio (LR) of PM by 1.8. Among the first-trimester parameters, taking 0.4 MOM as the cutoff, the area under the curve (AUC), sensitivity, specificity, and LR of PlGF were 0.701, 79% 62% and 2.06, respectively. If the uterine artery pulsatility index (Ut PI) was >95th centile, the LR of PM was 5.3. In the second trimester, with Ut PI > 95th centile, the LR of PM was 6.1, followed by LR of 5.8 with high sFLT-1/PlGF ratio (AUROC -0.725). In the third trimester, the PlGF below the cutoff had sensitivity, specificity, and negative predictive value of 62.5%,60.7%, and 99.2%, respectively.

We found that PlGF and UtA-PI are good markers for PM prediction.