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Fondos FEDER, Objective To analyze the ability to predict perinatal survival and severe neonatal morbidity of cases with early-onset fetal growth restriction (eoFGR) using maternal variables, ultrasound parameters and angiogenic markers at the time of diagnosis. Methods This was a prospective observational study in a cohort of singleton pregnancies with a diagnosis of eoFGR (< 32 weeks of gestation). At diagnosis of eoFGR, complete assessment was performed, including ultrasound examination (anatomy, biometry and Doppler assessment) and maternal serum measurement of the angiogenic biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). Logistic regression models for the prediction of perinatal survival (in cases diagnosed at < 28 weeks) and severe neonatal morbidity (in all liveborn cases) were calculated. Results In total, 210 eoFGR cases were included, of which 185 (88.1%) survived perinatally. The median gestational age at diagnosis was 27 + 0 weeks. All cases diagnosed at ≥ 28 weeks survived. In cases diagnosed < 28 weeks, survivors (vs non-survivors) had a higher gestational age (26.1 vs 24.4 weeks), estimated fetal weight (EFW; 626 vs 384 g), cerebroplacental ratio (1.1 vs 0.9), PlGF (41 vs 18 pg/mL) and PlGF multiples of the median (MoM; 0.10 vs 0.06) and lower sFlt-1/PlGF ratio (129 vs 479) at the time of diagnosis (all P < 0.001). The best combination of two variables for predicting perinatal survival was provided by EFW and PlGF MoM (area under the receiver-operating-characteristics curve (AUC), 0.84 (95% CI, 0.75–0.92)). These were also the best variables for predicting severe neonatal morbidity (AUC, 0.73 (95% CI, 0.66–0.80)). Conclusions A model combining EFW and maternal serum PlGF predicts accurately perinatal survival in eoFGR cases diagnosed before 28 weeks of gestation. Prenatal prediction of severe neonatal morbidity in eoFGR cases is modest regardless of the model used. © 2022 The Authors. Ultrasound in Obstetrics & Gynecolog, European Commission, Ministerio de Economía, Industria y Competitividad (España), Instituto de Salud Carlos III (España), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

CRUE-CSIC (Acuerdos Transformativos 2022), Objective To analyze the ability to predict perinatal survival and severe neonatal morbidity of cases with early-onset fetal growth restriction (eoFGR) using maternal variables, ultrasound parameters and angiogenic markers at the time of diagnosis. Methods This was a prospective observational study in a cohort of singleton pregnancies with a diagnosis of eoFGR (< 32 weeks of gestation). At diagnosis of eoFGR, complete assessment was performed, including ultrasound examination (anatomy, biometry and Doppler assessment) and maternal serum measurement of the angiogenic biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). Logistic regression models for the prediction of perinatal survival (in cases diagnosed at < 28 weeks) and severe neonatal morbidity (in all liveborn cases) were calculated. Results In total, 210 eoFGR cases were included, of which 185 (88.1%) survived perinatally. The median gestational age at diagnosis was 27 + 0 weeks. All cases diagnosed at ≥ 28 weeks survived. In cases diagnosed < 28 weeks, survivors (vs non-survivors) had a higher gestational age (26.1 vs 24.4 weeks), estimated fetal weight (EFW; 626 vs 384 g), cerebroplacental ratio (1.1 vs 0.9), PlGF (41 vs 18 pg/mL) and PlGF multiples of the median (MoM; 0.10 vs 0.06) and lower sFlt-1/PlGF ratio (129 vs 479) at the time of diagnosis (all P < 0.001). The best combination of two variables for predicting perinatal survival was provided by EFW and PlGF MoM (area under the receiver-operating-characteristics curve (AUC), 0.84 (95% CI, 0.75–0.92)). These were also the best variables for predicting severe neonatal morbidity (AUC, 0.73 (95% CI, 0.66–0.80)). Conclusions A model combining EFW and maternal serum PlGF predicts accurately perinatal survival in eoFGR cases diagnosed before 28 weeks of gestation. Prenatal prediction of severe neonatal morbidity in eoFGR cases is modest regardless of the model used. © 2022 The Authors. Ultrasound in Obstetrics & Gynecolog, Instituto de Salud Carlos III (ISCIII), European Regional Development Fund (FEDER), Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

El objetivo de las tres publicaciones que componen esta Tesis Doctoral fue evaluar la capacidad del Índice de pulsatilidad medio de las arterias uterinas (IPm-AUt) y de los factores de equilibrio angiogénico sFlt-1 (soluble fms-like tyroxin kinase-1) y PlGF (placental growth factor) para P1. La predicción de Preeclampsia (PE) en gestantes de alto riesgo.P2. La confirmación o exclusión del diagnóstico de PE cuando existe sospecha clínica.P3. La predicción del riesgo de aparición de complicaciones maternas y neonatales y del intervalo de tiempo que transcurre hasta el parto en mujeres con PE. Métodos.P1, Estudio prospectivo observacional de 135 gestaciones únicas con al menos un criterio de alto riesgo. Se evaluó el rendimiento de un modelo cuantitativo y otro semi-cuantitativo previamente descritos para la predicción de la PE, basados en la evaluación secuencial del IPm-AUt entre las semanas 11positivo 0 - 13 positivo 6 y 19 positivo 0 - 22 positivo 0.P2, Se incluyeron gestantes con sospecha (n igual a 32) o diagnóstico confirmado (n igual a 60) de PE. Se evaluó el IPm-AUt y del cociente sFlt-1 PlGF de forma adicional al protocolo convencional de estudio ante un caso de PE.P3, Se incluyeron 51 gestaciones con PE precoz (mayor 34 semanas). Se evaluó el IPm-AUt y el cociente sFlt-1 PlGF en el momento del diagnostico y la asociación individual y en combinación de dichos marcadores con la aparición de resultados maternos y perinatales adversos y su asociación con el tiempo restante desde el diagnóstico de la PE hasta el parto. Conclusiones. P1. la evaluación de la evolución secuencial de las resistencias en las arterias uterinas entre el primer y segundo trimestre de la gestación es de utilidad para predecir el riesgo de padecer PE precoz en gestantes de alto riesgo.P2. La PE precoz se asocia de forma prácticamente invariable con valores elevados del cociente sFlt-1 PlGF y del IPm-AUt. La utilidad clínica tanto del IPm-AUt como del ratio sFlt-1 PlGF más allá de la semana