Maternal Mid-Trimester Placental Growth Factor and Uterine Artery Doppler Velocimetry in Evolution of Pre-Eclampsia

Background: Early detection of pre-eclampsia (PE) has become one of the fundamental goals of perinatal medicine. Although clinical symptoms of PE emerge after the 20th week of gestation, trophoblast invasion that is responsible for pathogenesis occurs in the first trimester. This study aimed to evaluate the clinical utility of the Placental Growth Factor and uterine artery Doppler velocimetry in the evolution of preeclampsia.

Methods: This was a cohort prospective study that was carried out on sixty pregnant women who were classified into 3 equal groups of pregnant women who had gestational age ranging from 20 to 26 weeks: the first group included pregnant women with normal pregnancy, the second group included pregnant women with mild preeclampsia, and the third group included cases with severe preeclampsia.

Results: The mean of gestational age at delivery was significantly lower in patients who had severe preeclampsia than those with mild preeclampsia and controls. In contrast, there was no significant difference in the mean gestational age at delivery of patients with mild preeclampsia and controls. As for serum glutamic-oxaloacetic transaminase (SGOT), the concentration increased significantly in cases with severe preeclampsia compared to that of mild preeclampsia and controls. However, there were non-significance differences between controls and cases with mild preeclampsia. Receiver Operating Characteristic (ROC) curve showed that perfusion index (PI) had significantly higher diagnostic accuracy than other indices in predicting the outcome of the pregnancy and uterine artery pulsatility index had significantly higher diagnostic accuracy than both placental growth factor (PlGF) and uterine artery resistance index in predicting the severity of preeclampsia.

Conclusions: Uterine artery Doppler screening is simple and non-invasive and there is a clear association of elevated mean uterine artery PI, respiratory index (RI), and also serum PlGF in the second trimester, with the occurrence of PE. Uterine artery pulsatility index (UAPI) was significantly associated with a high incidence of PE. The sensitivity or prediction is increased by adding serum marker PlGF and combinations provide an increase in the ability of prediction and determination compared to the tests used alone.