Predelivery placenta-associated biomarkers and computerized intrapartum fetal heart rate patterns.
| Autor: | Bowe S; Division of Obstetrics and Gynaecology, Oslo University Hospital Ullevål, Oslo, Norway (Drs Bowe, Mitlid-Mork, Staff, and Sugulle).; Faculty of Medicine, University of Oslo, Oslo, Norway (Drs Bowe, Mitlid-Mork, Distante, Staff, and Sugulle)., Mitlid-Mork B; Division of Obstetrics and Gynaecology, Oslo University Hospital Ullevål, Oslo, Norway (Drs Bowe, Mitlid-Mork, Staff, and Sugulle).; Faculty of Medicine, University of Oslo, Oslo, Norway (Drs Bowe, Mitlid-Mork, Distante, Staff, and Sugulle)., Gran JM; Faculty of Medicine, University of Oslo, Oslo, Norway (Drs Bowe, Mitlid-Mork, Distante, Staff, and Sugulle).; Oslo Centre for Biostatistics and Epidemiology, University of Oslo and Oslo University Hospital, Oslo, Norway (Dr Gran)., Distante S; Faculty of Medicine, University of Oslo, Oslo, Norway (Drs Bowe, Mitlid-Mork, Distante, Staff, and Sugulle).; Department of Biochemistry, Oslo University Hospital, Oslo, Norway (Dr Distante)., Redman CWG; Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom (Drs Redman and Georgieva)., Staff AC; Division of Obstetrics and Gynaecology, Oslo University Hospital Ullevål, Oslo, Norway (Drs Bowe, Mitlid-Mork, Staff, and Sugulle).; Faculty of Medicine, University of Oslo, Oslo, Norway (Drs Bowe, Mitlid-Mork, Distante, Staff, and Sugulle)., Georgieva A; Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom (Drs Redman and Georgieva)., Sugulle M; Division of Obstetrics and Gynaecology, Oslo University Hospital Ullevål, Oslo, Norway (Drs Bowe, Mitlid-Mork, Staff, and Sugulle).; Faculty of Medicine, University of Oslo, Oslo, Norway (Drs Bowe, Mitlid-Mork, Distante, Staff, and Sugulle). |
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| Jazyk: | angličtina |
| Zdroj: | AJOG global reports [AJOG Glob Rep] 2022 Dec 16; Vol. 3 (1), pp. 100149. Date of Electronic Publication: 2022 Dec 16 (Print Publication: 2023). |
| DOI: | 10.1016/j.xagr.2022.100149 |
| Abstrakt: | Background: Increasing syncytiotrophoblast stress in term and postdate placentas is reflected by increasing antiangiogenic dysregulation in the maternal circulation, with low "proangiogenic" placental growth factor concentrations and increased "antiangiogenic" soluble fms-like tyrosine kinase-1 concentrations. Imbalances in these placenta-associated proteins are associated with intrapartum fetal compromise and adverse pregnancy and delivery outcome. Cardiotocography is widely used to assess fetal well-being during labor, but it is insufficient on its own for predicting adverse neonatal outcome. Development of improved surveillance tools to detect intrapartum fetal stress are needed to prevent neonatal adverse outcome. Objective: This study aimed to assess whether predelivery circulating maternal angiogenic protein concentrations are associated with intrapartum computerized fetal heart rate patterns, as calculated by the Oxford System for computerized intrapartum monitoring (OxSys) 1.7 prototype. We hypothesized that in pregnancies with low "proangiogenic" placental growth factor levels, increased "antiangiogenic" soluble fms-like tyrosine kinase-1 levels, and increased soluble fms-like tyrosine kinase-1-placental growth factor ratio, the OxSys 1.7 prototype will generate more automated alerts, indicating fetal compromise. Our secondary objective was to investigate the relationship between maternal circulating placenta-associated biomarkers and rates of automated alerts in pregnancies with and without adverse neonatal outcome. Study Design: This was an observational prospective cohort study conducted at a single tertiary center from September 2016 to March 2020. Of 1107 singleton pregnancies (gestational week ≥37 +0 ), 956 had available prelabor and predelivery placental growth factor and soluble fms-like tyrosine kinase-1 concentrations and intrapartum cardiotocography recordings. All neonatal and delivery outcomes were externally reviewed and categorized into 2 groups-the "complicated" group (n=32) and the "uncomplicated" group (n=924)-according to predefined adverse neonatal outcome. Eight different cardiotocography features were calculated by OxSys 1.7: baseline at start of cardiotocography, baseline at end of cardiotocography, short-term variation at start, short-term variation at end, nonreactive initial trace, and throughout the entire cardiotocography, maximum decelerative capacity, total number of prolonged decelerations, and OxSys 1.7 alert. OxSys 1.7 triggered an alert if the initial trace was nonreactive or if decelerative capacity and/or the number of prolonged decelerations exceeded a predefined threshold. Included women and attending clinicians were blinded to both biomarker and OxSys 1.7 results. Results: Mean maternal placental growth factor concentration was lower in the group with OxSys 1.7 alert compared with the group without the alert (151 vs 169 pg/mL; P =.04). There was a weak negative correlation between predelivery high soluble fms-like tyrosine kinase-1 and low short-term variation start ( r Conclusion: More automated alerts indicative of fetal distress were generated by OxSys 1.7 in pregnancies with low maternal predelivery placental growth factor level, in line with likely increasing placental stress toward the end of the pregnancy. An antiangiogenic predelivery profile (lower placental growth factor) increased the rates of alerts more rapidly in pregnancies with adverse neonatal outcome compared with those without. We suggest that future studies developing and testing prediction tools for intrapartum fetal compromise include predelivery maternal placental growth factor measurements. (© 2022 The Authors.) |
| Databáze: | MEDLINE |
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