妊娠 34 周前,sFlt-1/PlGF 比值结果> 655 是否意味着必须在 2 天内早产?一项回顾性观察研究。

IF 1.7 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Cassandra Siepen, Shaun Brennecke
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引用次数: 0

摘要

导言子痫前期与不良围产期结局有关,包括胎儿生长受限(FGR)和早产。母体血清中可溶性酪氨酸激酶受体-1(sFlt-1)与胎盘生长因子(PlGF)的比值可用于评估子痫前期和胎儿畸形的胎盘功能障碍。如果在妊娠 34 周前测量的 sFlt-1/PlGF 比率大于 655(正常比率小于 38),则建议在 2 天内分娩。目的:评估妊娠 34 周前 sFlt-1/PlGF 比率大于 655 时 2 天内分娩的必要性:对一家妇产医院在 2016 年 9 月至 2022 年 11 月期间获得的所有 sFlt-1/PlGF 比率检测结果进行回顾性审核。主要结果是妊娠 20+0 周至 33+6 周之间的孕妇在比值大于 655 时的分娩时间。统计分析使用 IBM SPSS Statistics v29.0.0.0 进行:在研究期间,共有 33 名疑似或确诊为子痫前期和/或 FGR 的患者在妊娠 34+0 周之前的 sFlt-1/PlGF 比率大于 655。在比率大于 655 的病例中,中位分娩时间为 4 天(IQR 1.0-9.0),其中 14 例(42.4%)在 2 天以内分娩,8 例(24.2%)在 2-7 天之间分娩,11 例(33.3%)在 7 天以后分娩。分娩时间与比率测试时的胎龄之间存在明显的负相关(rs = -0.484,p = 0.004):本研究为使用 sFlt-1/PlGF 比值预测妊娠 34 周前测量的高比值 > 655 的孕妇即将分娩的风险提供了最新建议。我们的研究结果表明,根据比值水平和胎龄可对即将分娩的风险进行分层,结合其他临床评估结果,可用于计划分娩时机,并在分娩前考虑使用胎肺成熟皮质类固醇和神经保护性硫酸镁疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does a sFlt-1/PlGF ratio result > 655 before 34 weeks' gestation necessitate preterm delivery within 2 days? A retrospective observational study.

Introduction: Preeclampsia is associated with adverse perinatal outcomes, including fetal growth restriction (FGR) and preterm delivery. The maternal serum ratio of soluble fms-like tyrosine kinase receptor-1 (sFlt-1) to placental growth factor (PlGF) can be used to evaluate placental dysfunction in cases of preeclampsia and FGR. A need for delivery within 2 days has been recommended for sFlt-1/PlGF ratios > 655 (normal ratio < 38) measured before 34 weeks' gestation. However, few studies have assessed this recommendation in a real-world setting and there remains a need for further evidence-based guidance on the use of the ratio in delivery timing planning in this situation.

Aim: To assess the need for delivery within 2 days associated with sFlt-1/PlGF ratios > 655 before 34 weeks' gestation.

Methods: A retrospective audit of all sFlt-1/PlGF ratio test results obtained at a single maternity hospital between September 2016 and November 2022. The primary outcome was time to delivery after recording a ratio > 655 in patients with a pregnancy between 20 + 0 and 33 + 6 weeks' gestation. Statistical analysis was performed using IBM SPSS Statistics v29.0.0.0.

Results: During the study period a total of 33 patients with suspected or confirmed preeclampsia and/or FGR recorded sFlt-1/PlGF ratios > 655 before 34 + 0 weeks' gestation. Amongst cases with ratios > 655, median time to delivery was 4 days (IQR 1.0-9.0), with 14 (42.4%) delivering in ≤ 2 days, 8 (24.2%) delivering between 2 and 7 days and 11 (33.3%) delivering after 7 days. A significant inverse correlation was observed between time to delivery and gestational age at the time of ratio testing (rs = -0.484, p = 0.004).

Discussion: This study provides updated recommendations on the use of the sFlt-1/PlGF ratio in predicting the risk of imminent delivery amongst those with high ratios > 655 measured before 34 weeks' gestation. Our results suggest that the risk of imminent delivery can be stratified based on ratio level and gestational age, which in combination with the results of other clinical assessments, can be used to plan delivery timing and allow for considerations of fetal lung maturing corticosteroid and neuroprotective magnesium sulfate therapies prior to delivery.

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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
217
审稿时长
2-3 weeks
期刊介绍: The official journal of The European Association of Perinatal Medicine, The Federation of Asia and Oceania Perinatal Societies and The International Society of Perinatal Obstetricians. The journal publishes a wide range of peer-reviewed research on the obstetric, medical, genetic, mental health and surgical complications of pregnancy and their effects on the mother, fetus and neonate. Research on audit, evaluation and clinical care in maternal-fetal and perinatal medicine is also featured.
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