INTRODUCTION
Preeclampsia (PE) is a severe multisystem condition characterized by
hypertension and end-organ dysfunction. It complicates 2-8% of
pregnancies (1) and is a leading cause of maternal and neonatal
morbidity and mortality (2,3).
We can distinguish two entities in terms of pathophysiology, in one hand
late-onset PE (developed after 34 weeks’ gestation) and in the other
hand early-onset PE that is thought to be more related to placental
insufficiency (4–6), which confers higher maternal and neonatal risks
(3,7,8).
Expectant management improves neonatal outcome in selected cases of
early-onset PE (9,10). Thus, clinical decisions are determined by a
trade-off between reducing the risks of maternal complications by timely
delivery and minimizing the risks of prematurity by expectant
management. Therefore, a reliable prediction of maternal complications
is essential in selecting women for expectant management. So far, even
when multi-parametric risk-scoring is used, such prediction capacity is
still moderate (11,12).
Maternal levels of angiogenic factors at admission for suspected PE have
emerged as prognostic predictors, including placental growth factor
[PlGF], soluble fms-like tyrosine kinase 1 [sFlt-1] and the
sFlt-1/PlGF ratio. These factors have showed a good capacity in ruling
out maternal complications and a moderate capacity in predicting its
occurrence (13,14). In addition, they may predict the interval to
delivery in suspected PE (15). It has been also suggested that
longitudinal changes of the angiogenic factors levels may provide
additional prediction capacity for the occurrence of complications in
suspected PE (16). The performance of this capacity in women with
confirmed PE has been less explored. Sequential angiogenic factors
differences has been compared retrospectively between early and
late-onset PE (17) or described prospectively in women admitted with
mixed hypertensive disorders (18). However, the clinical value of the
angiogenic factors longitudinal changes has not been specifically
investigated in early-onset cases already meeting severity criteria,
which is the clinical presentation with the greatest risk of maternal
and fetal complications (19).
The objective of this study is to test in early-onset severe PE whether
the longitudinal changes in maternal anigiogenic factors levels improve
the prediction capacity of adverse outcome and time interval to
delivery.