Early fetal growth restriction: a new approach to guide the choice of management strategy


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Abstract

Background: Fetal growth restriction (FGR) affects about 10 to 15% of all pregnancies. FGR is a potential cause of preterm birth, preeclampsia (PE), and stillbirth. FGR is associated with a high risk of adverse outcomes both in the neonatal period and long term. Aim: To identify the threshold of angiogenic markers (sFlt-1, PlGF, and their ratios) to predict fetal deterioration during early FGR. Materials and methods: This was a prospective study of 80 pregnant women. The study group included 45 patients with early FGR. FGR was diagnosed by a decrease in the estimated fetal weight (EFW) below the 10th percentile and impaired umbilical artery (UA) blood flow. Subgroup IA consisted of 24/45 (53.33%) pregnant women with a stable fetal condition according to Doppler and CTG monitoring, who progressed to full-term delivery. Subgroup IB included 21/45 (46.67%) patients with a progressive fetal deterioration, including an increase in PI up to the absence of end-diastolic blood flow in the UA, a decrease in cerebro-placental ratio and a reduction in PI in MCA, no increase in fetometric ultrasound parameters, and questionable or pathological type of CTG. Results: In subgroup IA, sFlt-1and PlGF concentrations and sFlt-1/PlGF ratio were 54305 pg/ml, 82.67pg/ml, and 852.44, respectively. In subgroup IB, sFlt-1and PlGF concentrations and sFlt-1/PlGF ratio were 105001pg/ ml, 34.89 pg/ml, and 2888.92, respectively. Concentrations of sFlt-1, PlGF, and sFlt-1/PlGF in pregnant women with a healthy pregnancy were 11860 pg/ml, 705 pg/ml, and 19.1, respectively. The optimal cut-off values of PlGF and sFlt-1/PlGF were 52.7 pg/ml. and 1118.12. Conclusion: The study findings showed that patients in the two subgroups of early FGR had statistically significant different levels of angiogenic markers. PlGF level ≥ 52.7 pg/ml and/or sFlt-1/lGF ratio ≥ 1118.12 were predictive for a high risk of fetal deterioration and adverse perinatal outcomes. Our study showed the validity of using the studied angiogenic markers in pregnant women with early FGR. The findings support a recommendation to use these markers in clinical practice.

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About the authors

Elena V. Timokhina

I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia (Sechenov University)

Email: elena.timokhina@mail.ru
Dr. Med. Sci., Professor at the Department of Obstetrics, Gynecology and Perinatology 119991, Russia, Moscow, B. Pirogovskaya str., 2-4

Alexander N. Strizhakov

I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia (Sechenov University)

Email: kafedra-agp@mailru
Academician of the RAS, Professor, Head of the Department of Obstetrics, Gynecology and Perinatology 119991, Russia, Moscow, B. Pirogovskaya str., 2-4

Nicoleta V. Zafiridi

I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia (Sechenov University)

Email: zafiridisniki@mail.ru
PhD. Student at the Department of Obstetrics, Gynecology and Perinatology 119991, Russia, Moscow, B. Pirogovskaya str., 2-4

Irina A. Fedyunina

I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia (Sechenov University)

Email: irina.fedjunina@mail.ru
Ph.D., Teaching Assistant at the Department of Obstetrics, Gynecology and Perinatology 119991, Russia, Moscow, B. Pirogovskaya str., 2-4

Alexander G. Aslanov

I.M. Sechenov First Moscow State Medical University Ministry of Health of Russia (Sechenov University)

Email: aslanov7@bk.ru
Ph.D., Associate Professor at the Department of Obstetrics, Gynecology and Perinatology 119991, Russia, Moscow, B. Pirogovskaya str., 2-4

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