Xiaodan Di

174. Evaluation of sFlt-1/PlGF ratio for improving clinical management of pre-eclampsia: Experience in a tertiary hospital

Introduction Management of pregnant women with gestational hypertension (GH) varies according to the severity of the disease. An imbalance of soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), is involved in pre-eclampsia (PE) pathogenesis. An elevated ratio(>110) is highly predictive of PE, whereas the diagnosis of PE can be ruled out within one week for low ratio( Objective The main objective of this study was to assess whether the cutoff value in late pregnancy (>34 weeks) help to management the preeclampsia. Methods We performed an observational study to evaluate serum sFlt-1/PlGF ratio (Roche Diagnostics Cobas e411 system) for differential diagnosis and the severity of disease from 2018 February to April (three months). Thirty-seven women with singleton pregnancies diagnosis withsuspected preeclampsia were enrolled. Serum sFlt-1 and PlGF were measured when they admitted (>34 weeks). The sFlt-1, PlGF, and the maternal clinical data were obtained. Results Among the 37 patients included, 25 had a sFlt-1/PlGF ratio lower than 38; only one diagnosis with PE leading to a negative predictive value of 96%. Two patients diagnosed with clinical PE as the ratio higher than 110. For the rest 10 patients had a sFlt-1/PlGF ratio between 38 and 110, four of them diagnosis with clinical PE. There were five patients with thrombocytopenia, the sFlt-1/PlGF ratio were all lower than 38 and rule out for HELLP. All patients were delivered without adverse maternal and neonatal outcomes. Discussion The serum sFlt-1/PlGF ratio showed highly value of differential diagnosis for ruling out PE. In our data, four of ten patients had a sFlt-1/PlGF ratio between 38 and 110 diagnosed with clinical PE, the cutoff value may be considering more clinical experience. Using these biomarkers in routine management of PE may improve clinical management of suspect patients. It need more clinical experience in future.

Neuroimaging findings in women who develop neurologic symptoms in severe preeclampsia with or without eclampsia

Eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide, and its pathogenesis remains elusive. Our objective was to investigate neuroimaging findings in women who developed neurologic symptoms in severe preeclampsia with or without eclampsia to further understand the relationship between neuroimaging findings and the pathogenesis of eclamptic seizures. This retrospective study included 79 women with severe preeclampsia/eclampsia who underwent brain MRI/CT examination between 2005 and 2017. We analyzed imaging findings, clinical data, and laboratory data in order to compare patients with severe preeclampsia to those with eclampsia and patients with abnormal imaging findings to those with normal CT or MRI. A total of 41 of 79 women were diagnosed with eclampsia, 36 (88.80%) of which had abnormal neuroimaging findings, including cerebral edema (19 cases), infarction (5 cases), cerebral venous thrombosis (5 cases), and cerebral hemorrhage (7 cases). Five patients died of cerebral hemorrhage. Of the 38 cases of severe preeclampsia, 21 (55.26%) cases had abnormal imaging findings, including cerebral edema (20 cases), and 1 case had cerebral hemorrhage. Serum uric acid was significantly higher in patients with abnormal imaging findings than in patients without them (P = 0.004). The imaging findings in women with neurologic symptoms were similar between the severe preeclampsia and eclampsia groups. Our results suggest that eclampsia may not be a diagnosis with a unique pathogenesis; rather, it may be best considered a severe symptom of the intracranial pathophysiology of preeclampsia. We suggest that cranial imaging should be performed early in the management of patients with severe preeclampsia who develop new neurologic symptoms.