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Aim: To evaluate if maternal serum soluble fms-like tyrosine kinase-1(sFlt-1) to placental growth factor (PlGF) ratio levels at term can anticipate the following adverse pregnancy outcomes: small for gestational age neonates; operative delivery for suspected fetal welfare compromise; and neonatal compromise., Methods: A retrospective analysis of a single hospital database containing antenatal soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio results together with associated demographic, clinical and investigative information. Subjects with antenatal sFlt-1/PlGF measurements taken ≥37 weeks' gestation were analyzed. sFlt-1/PlGF ratio cut-offs of <38, 38-110, 111-201 and >201 were tested against the following outcomes: birthweight ≤10th and ≤3rd centiles; operative delivery for suspected fetal welfare compromise; 5 min Apgar score; and neonatal admissions for extra care., Results: Statistically significant associations were found between sFlt-1/PlGF ratios 111-201 and birthweights ≤10th centile (p < 0.01, odds ratio [OR] 3.04, 95% confidence interval [CI] 1.52-6.10), and between operative delivery for suspected fetal welfare compromise and sFlt-1/PlGF ratios 111-201 (p = 0.04, OR 2.21, 95% CI 1.03-4.75) and >201 (p = 0.01, OR 4.73, 95% CI 1.45-15.4)., Conclusions: This study indicates that maternal serum sFlt-1/PlGF ratios performed at term may subsequently help identify significantly small-for-gestational age fetuses and operative delivery for suspected fetal welfare compromise. Further prospective studies may confirm these findings and substantiate the clinical importance of sFlt-1/PlGF measurements in assisting the management of pregnancies at term., (© 2025 Japan Society of Obstetrics and Gynecology.)

Background: Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy., Aims: To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period., Materials and Methods: A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed., Results: The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry., Conclusions: Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation., (© 2023 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)