VP50.13: Longitudinal evaluation of sFlt1/PlGF ratio to predict maternal and fetal complications in pregnancies with hypertensive disorders

Measuring sFlt1/PlGF ratio in pregnancies with hypertensive disorder (HDP) and IUGR is extremely helpful for risk stratification. Its longitudinal evaluation allows monitoring the progress of the disease. We studied the evolution of sFlt1/PlGF ratio in HDP in order to assess its validity. This is a longitudinal, observational study with a cohort of patients from our High-Risk Unit from January 2019 to February 2020. We chose 106 singleton pregnancies who underwent single or repeated sFlt1/PlGF evaluation for HDP, either isolated (HDP-AGA) or associated with IUGR (HDP-IUGR). We subsequently distinguished two groups: uncomplicated pregnancies and cases with maternal or fetal complications such as hypertensive crisis, symptomatic pre-eclampsia, HELLP, abruptio placentae, stillbirth, delivery <32 weeks on maternal indication, Apgar <7 at 5 minutes. Serum PlGF and sFlt-1 levels were measured on Cobas e601 platform (Roche Diagnostics). Cut-offs for sFlt1/PlGF ratio were 85 and 110 before and after 34 weeks. In HDP-AGA patients, repeated sFlt1/PlGF ratio was obtained in 7 cases. In the absence of complications (3 cases), sFlt1/PlGF ratio was in all cases low and stable (mean value 34 ± 21) with a daily increase of 0,3. In cases with maternal or fetal complication the mean value was 444 ± 410 and an average daily increase of 22 was observed. In complicated HDP-IUGR (11 cases) a high sFlt1/PlGF ratio was found. The mean value was 338 ± 165. Instead, among the 12 patients with HDP-IUGR with no maternal or fetal complication, mean value was 189 ± 169 (p 0,04). Longitudinal increase was less pronounced resulting in a less efficient risk stratification associated with a low gestational age at delivery. Maternal and fetal complications were predicted by a high sFlt1/PlGF ratio. Longitudinal evaluation reflected the progressive worsening of placental oxidative stress, although considering peculiarities of the underlying disease.