Julia Binder

Longitudinal assessment of HLA and MIC-A antibodies in uneventful pregnancies and pregnancies complicated by preeclampsia or gestational diabetes

The significance of antibodies directed against paternal epitopes in the context of obstetric disorders is discussed controversially. In this study anti-HLA and anti-MIC-A antibodies were analysed in sera of women with uneventful pregnancy (n = 101), preeclampsia (PE, n = 55) and gestational diabetes (GDM, n = 36) using antigen specific microbeads. While two thirds of the women with uneventful pregnancy or GDM were HLA and MIC-A antibody positive in gestational week 11 to 13 with a modest increase towards the end of pregnancy, women with PE showed an inverse kinetic: 90% were HLA antibody positive in gestational week 11 to 13 and only 10% showed HLA reactivities at the end of the pregnancy. HLA antibody binding strength was more pronounced in gestational week 14 to 17 in patients with PE compared to women with uneventful pregnancy (maximum median fluorescence intensity of the highest ranked positive bead 7403, IQR 2193–7938 vs. 1093, IQR 395–5689; p = 0.04) and was able to predict PE with an AUC of 0.80 (95% CI 0.67–0.93; p = 0.002). Our data suggest a pathophysiological involvement of HLA antibodies in PE. HLA antibody quantification in early pregnancy may provide a useful tool to increase diagnostic awareness in women prone to develop PE.

De‐novo abnormal uteroplacental circulation in third trimester: pregnancy outcome and pathological implications

Hypertensive disorders of pregnancy (HDP) are associated with impaired placentation, as evidenced by abnormal uterine artery (UtA) Doppler. In normal pregnancy, mean UtA pulsatility index (PI) shows a progressive decline with gestational age (GA). However, previous studies have reported that a proportion of pregnancies demonstrate worsening UtA Doppler in later pregnancy. The aim of this study was to investigate the incidence of HDP according to the change in mean UtA‐PI between the second and third trimesters.

Reduced fetal movements and cerebroplacental ratio: evidence for worsening fetal hypoxemia

To investigate the fetal cerebroplacental ratio (CPR) in women presenting with reduced fetal movements (RFM).

Prevalence, antenatal management and perinatal outcomes of monochorionic monoamniotic twin pregnancies: a collaborative multicentre study in England, 2000‐2013

To determine the prevalence of monochorionic monoamniotic (MCMA) twin pregnancy and to describe perinatal outcome and clinical management of these pregnancies.

An sFlt-1:PlGF ratio of 655 is not a reliable cut-off value for predicting perinatal outcomes in women with preeclampsia

OBJECTIVES The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is increased in preeclampsia. This study evaluated perinatal outcomes in cases with an sFlt-1:PlGF ratio above 655. STUDY DESIGN We retrospectively analyzed data from all consecutive women with singleton pregnancies who presented with clinically manifest preeclampsia and underwent immediate sFlt-1:PlGF assessment. Cases with an sFlt-1:PlGF ratio ≥ 655 were matched 1:1 for gestational age to controls with a ratio < 655. MAIN OUTCOME MEASURES The 5-min Apgar score and the arterial cord pH. RESULTS There was a significant association of sFlt-1:PlGF ratios ≥ 655 with fetal distress (40% in cases vs. 3.3% in controls; p < .01) and neonatal sepsis (23.3% vs. 0%; p = .02), but not with impaired Apgar score (9 vs. 9 at 5 min; p = .45) or lower arterial cord pH (7.24 ± 0.09 vs. 7.26 ± 0.08; p = .73). Perinatal mortality (20% vs. 16.7%; p = .9), intrauterine growth restriction (IUGR; 30% vs. 13.3%; p = .2), and small-for-gestational-age fetuses (SGA; 30% vs. 16.7%; p = .35) were proportionally distributed among cases and controls. IUGR and SGA diagnoses were most common in cases with sFlt1:PlGF ratios ≥ 1000, as was respiratory distress. CONCLUSIONS An sFlt-1:PlGF ratio above 655 is not predictive of impaired perinatal outcomes, and insufficiently reliable for predicting outcomes in cases with clinical signs of preeclampsia. Our data suggest that an extremely high sFlt-1:PlGF ratio above 1000 might be more useful.

Dynamics of serum C-type natriuretic peptide as predictor for preeclampsia

OBJECTIVE To evaluate serum levels of the amino-terminal propeptide of C-type natriuretic peptide (NTproCNP) in uneventful pregnancies and pregnancies complicated by preeclampsia (PE) and NTproCNPs accuracy for prediction of PE. STUDY DESIGN Nested case control pilot study including women with uneventful pregnancy (Control, n = 100) and asymptomatic women who later developed PE (PE_long, n = 12). NTproCNP levels were measured in a maximum of ten sequential blood samples per patient (seven visits during pregnancy, three afterwards), which had been collected prospectively. RESULTS In controls, NTproCNP decreased from weeks 11-13 on, reaching a nadir at the end of the second trimester (weeks 23-27), and subsequently reached the highest levels at the end of pregnancy. In comparison, the PE_long group showed a significantly different NTproCNP course (p = .042), including significantly elevated levels in weeks 18-22 (p = .034) and 23-27 (p = .016). Significant predictive power of single time point measurements of NTproCNP for predicting short-term occurrence of preeclampsia in asymptomatic women was found in weeks 28-32 (p = .023) and 33-36 (p = .014). Furthermore, an increase > -0.038 pmol/l per week between weeks 11-13 and 14-17 was also predictive for PE (area under the curve, AUC: 0.75; p < .001; sensitivity: 90%; specificity: 60%), as was an increase of > 0.084 pmol/l per week between weeks 11-13 and 18-22 (AUC: 0.69, p = .048; sensitivity: 55%; specificity: 88%). CONCLUSIONS Measurement of NTproCNP in pregnancy might be useful to increase diagnostic awareness in women who will develop PE.

OP17.07: Worsening of the uterine artery Doppler is associated with the development of hypertensive disorders of pregnancy

Objectives: To assess quality of measurements of mean arterial pressure (MAP), mean uterine artery pulsatility index (UtPI), pregnancy-associated plasma protein A (PAPP-A) and placental growth factor (PlGF) in first trimester screening for pre-eclampsia program. Methods: Consecutive patients attending first trimester screening for aneuploidies in a large practice in Sydney, Australia, from May 2014 to February 2017 also had combined screening for pre-eclampsia based on the Fetal Medicine Foundation (FMF) algorithm. Distributions of MAP, UtPI, PAPP-A and PlGF, expressed as multiples of the median (MoM) were plotted in relation to the previously published UK median. Temporal analyses were produced by cumulative sum charts (CUSUM) and monthly distributions. Central tendency and dispersion charts were also produced for each individual UtPI operator. Results: 26,543 women attended for first trimester assessment and 21,010 had screening for pre-eclampsia with all four markers measured. Median MAP (n=26,450) UtPI (n=25,672), PAPP-A (n=23,471) and PlGF (n=21,723) MoM were 0.959, 1.031, 1.137 and 0.977, respectively. Of those, MAP and PAPP-A measurements were outside the expected range (±0.2 SD Log10[MoM]), and PlGF had a negative bias after March 2016. Most sonographers (40/46) measured UtPI within the acceptable range. The screen positive rate (SPR) for preterm pre-eclampsia, using a cut-off of 1:100, was 11.8%, similar with previous validation studies. Conclusions: While slight variations on biomarkers could be due to population characteristics and are unlikely to have major consequences on detection rate, bigger biases might affect significantly the SPR. Therefore, quality assurance process is essential in a first trimester screening program.

OP27.05: Variants of abnormal placentation: retrospective analysis of selected cases and possible clinical implications

Methods: We retrospectively reviewed those cases of placenta previa totalis with the suspicion of AIP during the period between Feb 2002 and Mar 2017. In these cases, both transabdominal and transvaginal ultrasound were performed. A targeted scanning was directed towards the flow signals between the placenta and bladder mucosa. ‘‘Rail’’ sign indicated two parallel flow signals of subplacental and bladder mucosa region with interconnected bridging vessels perpendicular to them. All these patients received ultrasound examination and operation at our hospital. Results: In this cohort, we have more than 850 cases of persistent placenta previa. Among them, 138 consecutive cases of AIP were confirmed during operation. In addition to those common ultrasound descriptors, we disclosed ‘‘rail’’ sign by colour Doppler in 18 out of 21 cases of placenta percreta, 32 out of 84 of placenta increta and none of the remaining cases of placenta accreta. Among these AIPs with ‘‘rail’’ sign, 8 received complicated subtotal hysterectomy and 42 underwent simple hysterectomy (compared to 52 hysterectomies out of 88 patients without rail sign). Bladder injury occurred in 6 patients with rail sign (compared to none in the remaining cases without rail sign). Conclusions: ‘‘Rail’’ sign by colour Doppler either by transabdominal or transvaginal ultrasound identifies the advanced AIP (such as placenta increta and percreta), and predicts the higher possibility for hysterectomy and bladder injury.