title: Biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.
abstract: OBJECTIVE
  To investigate the potential value of biophysical and biochemical markers at 30-34 weeks' gestation in the prediction of adverse perinatal outcome.
  
  
  METHODS
  This was a screening study in 8268 singleton pregnancies at 30-34 weeks' gestation. Estimated fetal weight (EFW), uterine artery (UtA) pulsatility index (PI), umbilical artery (UA) PI, fetal middle cerebral artery (MCA) PI, mean arterial pressure (MAP), serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured. The detection rate (DR) and false-positive rate (FPR) of screening by each biomarker were estimated for stillbirth, pre-eclampsia, delivery of small-for-gestational-age (SGA) neonate, Cesarean section for fetal distress before or during labor, umbilical arterial cord blood pH ≤7.0 or umbilical venous cord blood pH ≤7.1, 5-min Apgar score < 7 and admission to the neonatal unit (NNU).
  
  
  RESULTS
  Multivariable regression analysis demonstrated that significant prediction of PE was provided by PlGF, sFlt-1, MAP and MCA-PI, with a DR of 98% for PE delivering < 37 weeks' gestation and 56% for those delivering ≥ 37 weeks, at a 10% FPR. Prediction of SGA was provided by EFW, PlGF, sFlt-1, UtA-PI, UA-PI and MCA-PI, with a DR of 88% for SGA delivering < 37 and 51% for those delivering ≥ 37 weeks' gestation, at a 10% FPR. Prediction of stillbirth was provided by EFW, UtA-PI and MCA-PI, with DR of 30% at 10% FPR. Prediction of Cesarean section for fetal distress before labor was provided by EFW, sFlt-1, UtA-PI and UA-PI, with a DR of 90% at a 10% FPR. Prediction of fetal distress in labor was provided by EFW and sFlt-1, with a DR of 16% at a 10% FPR. There were no significant differences from the normal outcome group in any of the biomarkers for low cord blood pH, low Apgar score or NNU admission for cases other than those with PE and/or SGA.
  
  
  CONCLUSIONS
  At 30-34 weeks' gestation, biomarkers of impaired placentation and fetal hypoxemia provide good prediction of PE, SGA and fetal distress before labor, but poor or no prediction of stillbirth and adverse events in labor or after birth.
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Valiño
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Giunta
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Gallo
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.|Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, Kent, UK.
authors.forename: R
authors.initials: R
authors.lastname: Akolekar
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
authors.forename: K H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D001034:Apgar Score; D062186:Arterial Pressure; D015415:Biomarkers / Q000032:analysis; D002585:Cesarean Section / Q000706:statistics & numerical data; D005189:False Positive Reactions; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005316:Fetal Distress / Q000175:diagnosis / Q000209:etiology; D020567:Fetal Weight; D005333:Fetus / Q000098:blood supply; D005865:Gestational Age; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008423:Maternal Age; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000175:diagnosis* / Q000209:etiology; D000072483:Placenta Growth Factor; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000209:etiology; D011256:Pregnancy Outcome; D011257:Pregnancy Proteins / Q000097:blood; D011263:Pregnancy Trimester, Third / Q000502:physiology*; D011446:Prospective Studies; D011673:Pulsatile Flow; D012044:Regression Analysis; D050497:Stillbirth; D016216:Ultrasonography, Prenatal / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D055988:Uterine Artery / Q000000981:diagnostic imaging; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000097:blood
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D040281:Vascular Endothelial Growth Factor Receptor-1
keywords: mean arterial pressure; middle cerebral artery Doppler; perinatal outcome; placental growth factor; pyramid of antenatal care; sFlt-1; third-trimester screening; umbilical artery Doppler; uterine artery Doppler