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PLGF RATIO IS ASSOCIATED WITH UNFAVORABLE HYPERTENSIVE PREGNANCY OUTCOME
Poster presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S531–S867
Materials: Were evaluated 96 pregnant women between the 20th and 35th week of gestation: 75 of which up to now hesitate in giving birth. The subjects were recruited at the Department of Obstetrics Gynecology, University of Cagliari, during the hospitalization or during the scheduled monitoring visits. Methods: In all subjects the assay of PlGF was performed with the instrument Triage Meter (Alere) by a fluorescence immunoassay on plasma samples obtained from blood collected in tubes with the anticoagulant EDTA. Symptoms of preeclampsia, doppler velocimetry of uterine artery and umbilical vein and the timing of delivery were evaluated in all subjects. After the delivery infant weight at the birth, the APGAR index and the macroscopic evaluation of the placenta were also performed. Placentas were sent to Pathology for hystologic examination. Statistical analysis we used is chi-square test. Results: The levels of PlGF classified two groups of subjects: “control group” with PlGF values within the normal range for gestational age, “study group” with PlGF levels lower than the cut off for gestational age. The evaluation on the prediction of PlGF on both fetal and maternal outcome, and placental morphology was performed on 75 pregnant women who delivered up to now. In the study group, the percentage of preterm births, abnormal flow meters, preeclampsia, and low birth weight infants was significantly higher (p-value <0.001) than in the control group. In the control group the percentage of macroscopically and microscopically normal placentas was significantly higher (p-value <0.0002) than in the study group. Conclusions: These preliminary data suggest that PlGF is a good indicator of placental function, particularly of the placental perfusion. PlGF values below the cut-off for gestational age is related with histological alterations of the placenta, commonly reported in chronic hypoxia. These preliminary results suggest also that low PlGF levels are associated with earlier timing of delivery and low newborn weight at the birth. W240 INCREASED SFLT-1/PLGF RATIO IS ASSOCIATED WITH UNFAVORABLE HYPERTENSIVE PREGNANCY OUTCOME V. Taraseviciene1 , R. Maciuleviciene1 , R. Grybauskiene2 , D. Simanaviciute1 . 1 Lithuanian University of Health Sciences, Obstetrics and Gynecology department, Kaunas, Lithuania; 2 Lithuanian University of Health Sciences, Cardiology Institute, Kaunas, Lithuania Objectives: To investigate sFlt-1/PlGF ratio’s correlation with uterine artery blood flow and it’s predictive value for unfavorable pregnancy outcome in preterm hypertensive pregnancies. Materials: Our study included 121 pregnant women before term: 65 patients with hypertensive pregnancy disorders that where admitted to Kaunas perinatal centre (47 with preeclampsia, 7 with gestational hypertension and 11 with primary hypertension) and 66 age, parity and gestational age matched controls. Methods: Mean uterine artery pulsatility index (PI) and presence of prothodiastolic notches were registered. Maternal serum sFlt-1 and PlGF levels were measured, sFlt-1/PlGF ratio was calculated. The cutt off value of 35 was used for sFlt-1/PlGF ratio. Differences between numerical variables were compared using Mann-Whitney test and Spearman correlation (r) was used to calculate the correlation between variables. Sensitivity, specificity, negative and possitive predictive values and odds ratios were calculated. Results: The mean SFlt-1/PlGF ratio in preeclampsia group was 305.38 (±267.6) and 6.8 ((±16.4) in controls. Mean uterine artery PI in preeclampsia group and controls was 1.26 (±0.4) and 0.82 (±0.2) correspondingly. SFlt-1/PlGF ratio and mean uterine artery PI were significantly higher in preeclamptic patients (p < 0.001) compared to controls. SFlt-1/PlGF ratio above 35 correlated significantly with abnormal uterine artery blood flow and was predictive for preeclampsia, especially the early onset one, prematurity and
S783
cesarean section (p < 0.005). We did not find sFlt-1/PlGF ratio correlation with interval to delivery length. Conclusions: SFlt-1/PlGF ratio above 35 is correlated with abnormal uterine artery blood flow and can predict preeclampsia, the need of preterm delivery and cesarean section. W241 USE OF SULFOSALICYLIC ACID IN THE PROMPT DETECTION OF PROTEINURIA IN PREGNANCY AND ITS APPLICATION IN THE HYPERTENSIVE PROBLEMS RELATED TO PREGNANCY 1 J. Velasquez ` , J.J. Zuleta2 , J. Lopez3 , N. Gomez3 . 1 Hospital Universitario San Vicente Fundaci´ on and Nacer Universidad de Antioquia, Medellìn, Antioquia, Colombia; 2 Centro Nacer – Universidad de Antioquia, Medell´ın, Antioquia, Colombia; 3 Universidad de Antioquia, Medell´ın, Antioquia, Colombia Objectives: Determine the reliability and accuracy (esta ultima palabra es opcional) of the sulfosalisylic acid test in the fast measurement of proteinuria. Materials: Prospective, descriptive study at the University Hospital San Vicente de Paul, Colombia. 98 women with proteinuria and 129 without proteinuria were included in the study. The turbid test with sulfosalicylic acid was compared to the proteinuria in 24 hours. Methods: As the patients were admitted at the emergency room, a 5 ml urine sample was recollected in a essay tube and was mixed with 5 ml of 3% sulfosalicylic acid. This mixture was gently agitated for 60 seconds and in the following 2 minutes the turbidness was interpreted by a visual scale appraisement chart available in the emergency room. Three different observers independently evaluated the turbidity: the intern, the resident doctor and the obstetrician. All the information was downloaded into a data base designed in the Excel 2000 program and the analysis was done with the SPSS 14.0 and Epidat 3.1 programs. Results: The LR (likelihood ratio) for the turbid test of 1+, 2+, 3+, 4+ and 5+ was of 0.4, 0.7, 3.4, 6.7 and 39.1 respectively. The interclass correlation between evaluators was 0.966. With one cut point of 4+ the sensitivity was 41.05% (CI 95% 30.63– 51.47), the specificity was 97.66% (CI 94.64–100). In the hypertensive patients, the positive predictive value was 95% (CI 87–100) and the negative predictive value was 53.3% (CI 95% 42.5–64). Table 1 shows the description of the population studied. Conclusions: The turbid test is an easy, fast and reproducible test. Because of its high specificity it is ideal for the confirmation of proteinuria during pregnancy induced hypertension patients. Table: Description of population in study Proteinuria mg/24 hours Patient’s age Gestational age (weeks) Blood pressure at admission (mmHg) Systolic Diastolic Number of previous pregnancies Urinary’s PH Urinary’s density (mg/dl)
Without proteinuria
With proteinuria
137 (91.5–185.5) 23 (19–29.8) 33 (29–35)
901.5 (429.3–2153.5) 24 (19–31) 33.5 (30–36)
120 (110–140) 80 (70–95) 2 (1–4) 6 (5.5–6.5) 1015 (1010–1023)
150 (140–160) 100 (90–100) 2 (1–3) 6 (5.5–6.5) 1015 (1010–1020)
All values are median and 25th and 75th percentiles.
W242 A COHORT EVALUATION ON THE EFFECT OF OBESITY ON CENTRAL AORTIC PRESSURES AS MEASURES OF ARTERIAL STIFFNESS IN PREGNANCY W.Y. Lim1,3 , K.Y.C. Kwek1,3 , Y.-S. Chong1,2 , Y.-H. Chan1 , S.M. Saw1,2 . 1 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; 2 NUHS, Singapore, Singapore; 3 KK Women’s & Children’s Hospital, Singapore, Singapore Objectives: To evaluate the effects of obesity as denoted by prepregnancy body mass index in kg/m2 and rate of weight gain in kg/week on central aortic systolic and pulse pressures derived from radial artery pulsewave forms.
Materials: Were evaluated 96 pregnant women between the 20th and 35th week of gestation: 75 of which up to now hesitate in giving birth. The subjects were recruited at the Department of Obstetrics Gynecology, University of Cagliari, during the hospitalization or during the scheduled monitoring visits. Methods: In all subjects the assay of PlGF was performed with the instrument Triage Meter (Alere) by a fluorescence immunoassay on plasma samples obtained from blood collected in tubes with the anticoagulant EDTA. Symptoms of preeclampsia, doppler velocimetry of uterine artery and umbilical vein and the timing of delivery were evaluated in all subjects. After the delivery infant weight at the birth, the APGAR index and the macroscopic evaluation of the placenta were also performed. Placentas were sent to Pathology for hystologic examination. Statistical analysis we used is chi-square test. Results: The levels of PlGF classified two groups of subjects: “control group” with PlGF values within the normal range for gestational age, “study group” with PlGF levels lower than the cut off for gestational age. The evaluation on the prediction of PlGF on both fetal and maternal outcome, and placental morphology was performed on 75 pregnant women who delivered up to now. In the study group, the percentage of preterm births, abnormal flow meters, preeclampsia, and low birth weight infants was significantly higher (p-value <0.001) than in the control group. In the control group the percentage of macroscopically and microscopically normal placentas was significantly higher (p-value <0.0002) than in the study group. Conclusions: These preliminary data suggest that PlGF is a good indicator of placental function, particularly of the placental perfusion. PlGF values below the cut-off for gestational age is related with histological alterations of the placenta, commonly reported in chronic hypoxia. These preliminary results suggest also that low PlGF levels are associated with earlier timing of delivery and low newborn weight at the birth. W240 INCREASED SFLT-1/PLGF RATIO IS ASSOCIATED WITH UNFAVORABLE HYPERTENSIVE PREGNANCY OUTCOME V. Taraseviciene1 , R. Maciuleviciene1 , R. Grybauskiene2 , D. Simanaviciute1 . 1 Lithuanian University of Health Sciences, Obstetrics and Gynecology department, Kaunas, Lithuania; 2 Lithuanian University of Health Sciences, Cardiology Institute, Kaunas, Lithuania Objectives: To investigate sFlt-1/PlGF ratio’s correlation with uterine artery blood flow and it’s predictive value for unfavorable pregnancy outcome in preterm hypertensive pregnancies. Materials: Our study included 121 pregnant women before term: 65 patients with hypertensive pregnancy disorders that where admitted to Kaunas perinatal centre (47 with preeclampsia, 7 with gestational hypertension and 11 with primary hypertension) and 66 age, parity and gestational age matched controls. Methods: Mean uterine artery pulsatility index (PI) and presence of prothodiastolic notches were registered. Maternal serum sFlt-1 and PlGF levels were measured, sFlt-1/PlGF ratio was calculated. The cutt off value of 35 was used for sFlt-1/PlGF ratio. Differences between numerical variables were compared using Mann-Whitney test and Spearman correlation (r) was used to calculate the correlation between variables. Sensitivity, specificity, negative and possitive predictive values and odds ratios were calculated. Results: The mean SFlt-1/PlGF ratio in preeclampsia group was 305.38 (±267.6) and 6.8 ((±16.4) in controls. Mean uterine artery PI in preeclampsia group and controls was 1.26 (±0.4) and 0.82 (±0.2) correspondingly. SFlt-1/PlGF ratio and mean uterine artery PI were significantly higher in preeclamptic patients (p < 0.001) compared to controls. SFlt-1/PlGF ratio above 35 correlated significantly with abnormal uterine artery blood flow and was predictive for preeclampsia, especially the early onset one, prematurity and
S783
cesarean section (p < 0.005). We did not find sFlt-1/PlGF ratio correlation with interval to delivery length. Conclusions: SFlt-1/PlGF ratio above 35 is correlated with abnormal uterine artery blood flow and can predict preeclampsia, the need of preterm delivery and cesarean section. W241 USE OF SULFOSALICYLIC ACID IN THE PROMPT DETECTION OF PROTEINURIA IN PREGNANCY AND ITS APPLICATION IN THE HYPERTENSIVE PROBLEMS RELATED TO PREGNANCY 1 J. Velasquez ` , J.J. Zuleta2 , J. Lopez3 , N. Gomez3 . 1 Hospital Universitario San Vicente Fundaci´ on and Nacer Universidad de Antioquia, Medellìn, Antioquia, Colombia; 2 Centro Nacer – Universidad de Antioquia, Medell´ın, Antioquia, Colombia; 3 Universidad de Antioquia, Medell´ın, Antioquia, Colombia Objectives: Determine the reliability and accuracy (esta ultima palabra es opcional) of the sulfosalisylic acid test in the fast measurement of proteinuria. Materials: Prospective, descriptive study at the University Hospital San Vicente de Paul, Colombia. 98 women with proteinuria and 129 without proteinuria were included in the study. The turbid test with sulfosalicylic acid was compared to the proteinuria in 24 hours. Methods: As the patients were admitted at the emergency room, a 5 ml urine sample was recollected in a essay tube and was mixed with 5 ml of 3% sulfosalicylic acid. This mixture was gently agitated for 60 seconds and in the following 2 minutes the turbidness was interpreted by a visual scale appraisement chart available in the emergency room. Three different observers independently evaluated the turbidity: the intern, the resident doctor and the obstetrician. All the information was downloaded into a data base designed in the Excel 2000 program and the analysis was done with the SPSS 14.0 and Epidat 3.1 programs. Results: The LR (likelihood ratio) for the turbid test of 1+, 2+, 3+, 4+ and 5+ was of 0.4, 0.7, 3.4, 6.7 and 39.1 respectively. The interclass correlation between evaluators was 0.966. With one cut point of 4+ the sensitivity was 41.05% (CI 95% 30.63– 51.47), the specificity was 97.66% (CI 94.64–100). In the hypertensive patients, the positive predictive value was 95% (CI 87–100) and the negative predictive value was 53.3% (CI 95% 42.5–64). Table 1 shows the description of the population studied. Conclusions: The turbid test is an easy, fast and reproducible test. Because of its high specificity it is ideal for the confirmation of proteinuria during pregnancy induced hypertension patients. Table: Description of population in study Proteinuria mg/24 hours Patient’s age Gestational age (weeks) Blood pressure at admission (mmHg) Systolic Diastolic Number of previous pregnancies Urinary’s PH Urinary’s density (mg/dl)
Without proteinuria
With proteinuria
137 (91.5–185.5) 23 (19–29.8) 33 (29–35)
901.5 (429.3–2153.5) 24 (19–31) 33.5 (30–36)
120 (110–140) 80 (70–95) 2 (1–4) 6 (5.5–6.5) 1015 (1010–1023)
150 (140–160) 100 (90–100) 2 (1–3) 6 (5.5–6.5) 1015 (1010–1020)
All values are median and 25th and 75th percentiles.
W242 A COHORT EVALUATION ON THE EFFECT OF OBESITY ON CENTRAL AORTIC PRESSURES AS MEASURES OF ARTERIAL STIFFNESS IN PREGNANCY W.Y. Lim1,3 , K.Y.C. Kwek1,3 , Y.-S. Chong1,2 , Y.-H. Chan1 , S.M. Saw1,2 . 1 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; 2 NUHS, Singapore, Singapore; 3 KK Women’s & Children’s Hospital, Singapore, Singapore Objectives: To evaluate the effects of obesity as denoted by prepregnancy body mass index in kg/m2 and rate of weight gain in kg/week on central aortic systolic and pulse pressures derived from radial artery pulsewave forms.