P.I. Gómez-Arriaga

Uterine artery Doppler and sFlt‐1/PlGF ratio: usefulness in diagnosis of pre‐eclampsia

To evaluate the usefulness of the mean pulsatility index of the uterine arteries (mPI‐UtA) and automated measurement of the soluble fms‐like tyrosine kinase 1 (sFlt‐1)/placental growth factor (PlGF) ratio on suspicion or at diagnosis of pre‐eclampsia (PE).

Uterine artery Doppler and sFlt‐1/PlGF ratio: prognostic value in early‐onset pre‐eclampsia

To evaluate the performance of the mean uterine artery pulsatility index (UtA‐PI) and the automated measurement of the soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio for the prognostic assessment of both maternal and perinatal outcomes, and the time‐to‐delivery interval in early‐onset (≤u200934u2009+u20090u2009weeks) pre‐eclampsia (PE) cases with attempted expectant management.

Predictive value of sequential models of uterine artery Doppler in pregnancies at high risk for pre-eclampsia.

To evaluate the performance of models described previously for the prediction of pre‐eclampsia (PE), based on the sequential evaluation of uterine artery resistance at 11–13 weeks and 19–22 weeks, in a high‐risk population.

The role of angiogenic biomarkers and uterine artery Doppler in pregnant women with systemic lupus erythematosus or antiphospholipid syndrome

OBJECTIVEnTo evaluate the usefulness of the uterine artery mean pulsatility index (mPI-UtA) and the sFlt-1/PlGF ratio in women with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) for the prediction of placental dysfunction-related adverse outcomes (AO), namely pre-eclampsia (PE) and intrauterine growth restriction (IUGR), and for differential diagnosis between PE and SLE flares.nnnSTUDY DESIGNnObservational prospective cohort study of 57 pregnant women with SLE or APS.nnnMAIN OUTCOME MEASURESnmPI-UtA and sFlt-1/PlGF ratio in maternal serum were obtained at four gestational age periods (11-14, 19-22, 24-29 and 32-34u202fweeks). Comparisons among pregnancies with normal outcome, SLE flare and AO were performed.nnnRESULTSnOverall, we had 44 ongoing pregnancies (36 with SLE and 8 with APS) of which most (nu202f=u202f35, 80%) were uncomplicated. The overall rate of AO was 9% (nu202f=u202f4), that was diagnosed at a mean (SD) gestational age of 34.1 (7.5) weeks. Five SLE patients (14%) suffered a SLE flare. No differences for these markers were found between normal pregnancies and those affected by SLE flare. mUtA-PI values were significantly higher in the AO group when compared with normal and SLE flare groups, at 19-22u202fweeks (1.52, 0.95 and 0.76) and 32-34u202fweeks (1.13, 0.68 and 0.65), respectively. The sFlt-1/PlGF ratio was significantly higher in the AO group at 24-29u202fweeks (191.1, 3.1 and 9.2), respectively.nnnCONCLUSIONnOur preliminary results indicate that mPI-UtA and sFlt1/PlGF ratio may be useful to predict AO in women with SLE, and to make the differential diagnosis with a lupus flare.

Clinical implementation of the sFlt-1/PlGF ratio to identify preeclampsia and fetal growth restriction: A prospective cohort study

OBJECTIVEnTo analyze the usefulness of a clinical protocol for early detection of preeclampsia and/or fetal growth restriction (PE/FGR) using, in previously selected pregnancies, the measurement of the sFlt-1/PlGF ratio at 24-28u202fweeks of gestation.nnnSTUDY DESIGNnProspective observational cohort study carried out in a single tertiary hospital in Spain. 5601 consecutive singleton pregnancies with complete follow-up were included. High-risk women for PE/FGR were selected by combining data from maternal history and second trimester uterine artery Doppler. Subsequently these patients underwent intensive monitoring, including the measurement of the sFlt-1/PlGF ratio at 24-28u202fweeks to predict PE/FGR.nnnMAIN OUTCOME MEASURESnEarly, intermediate and late PE/FGR (delivery <32u202f+u202f0, 32u202f+u202f0 - <36u202f+u202f0 and ≥36u202f+u202f0u202fweeks, respectively).nnnRESULTSnOverall incidence of early, intermediate and late PE/FGR was 0.3%, 0.7% and 3.2%, respectively, being higher in the 4.3% of women selected for intensive monitoring: 5.8%, 8.7% and 15.4%, respectively (all pu202f<u202f0.001). The area under the curve (AUC) with 95%CI of the sFlt-1/PlGF ratio for detecting early PE/FGR was 0.98 (0.97-1.00), and the sFlt-1/PlGF ratio >95th centile showed a sensitivity (%) of 100 (95%CI, 78.5-100) and specificity (%) of 80.6 (95%CI, 75.0-85.2). The AUC of the sFlt-1/PlGF ratio for detecting intermediate and late PE/FGR was of 0.87 (95%CI, 0.77-0.97) and 0.68 (95%CI, 0.58-0.79), respectively.nnnCONCLUSIONnA contingent strategy of measuring the sFlt-1/PlGF ratio at 24-28u202fweeks in women previously selected by clinical factors and uterine artery Doppler enables an accurate prediction of PE/FGR. This performance is optimal to predict PE/FGR requiring delivery before 32u202fweeks.