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Duncan JR, Schenone CV, Običan SG. Third trimester uterine artery Doppler for prediction of adverse perinatal outcomes. Curr Opin Obstet Gynecol 2022; 34:292-299. [PMID: 35895911 DOI: 10.1097/gco.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Abnormal uterine artery Doppler (UtAD) studies early in gestation have been associated with adverse pregnancy outcomes. However, their association with complications in the third trimester is weak. We aim to review the prediction ability for perinatal complications of these indices in the third trimester. RECENT FINDINGS Abnormal UtAD waveforms in the third trimester are associated with preeclampsia, small-for-gestational age infants (SGA), preterm birth, perinatal death, and other perinatal complications, such as cesarean section for fetal distress, 5 min low Apgar score, low umbilical artery pH, and neonatal admission to the ICU, particularly in SGA infants. UtAD prediction performance is improved by the addition of maternal characteristics as well as biochemical markers to prediction models and is more precise if the evaluation is made closer to delivery or diagnosis. SUMMARY This review shows that the prediction accuracy of UtAD for adverse pregnancy outcomes during the third trimester is moderate at best. UtAD have limited additive value to prediction models that include PlGF and sFlt-1. Serial assessments rather than a single third trimester evaluation may enhance the prediction performance of the UtAD combined models.
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Affiliation(s)
- Jose R Duncan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
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Chen L, Pi Y, Chang K, Luo S, Peng Z, Chen M, Yu L. Screening models combining maternal characteristics and multiple markers for the early prediction of preeclampsia in pregnancy: a nested case–control study. J OBSTET GYNAECOL 2022; 42:1889-1896. [PMID: 35634766 DOI: 10.1080/01443615.2022.2054675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Li Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Pi
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Chang
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Sifu Luo
- Department of Obstetrics and Gynecology, Institute of Surgery Research, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhuyun Peng
- Department of Obstetrics and Gynecology, Institute of Surgery Research, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ming Chen
- Department of Clinical Laboratory Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lili Yu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Chilumula K, Saha PK, Muthyala T, Saha SC, Sundaram V, Suri V. Prognostic role of uterine artery Doppler in early- and late-onset preeclampsia with severe features. J Ultrasound 2020; 24:303-310. [PMID: 32797405 DOI: 10.1007/s40477-020-00524-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To correlate uterine artery Doppler findings with maternal and neonatal outcomes in early- and late-onset preeclampsia with severe features. METHODOLOGY Doppler scan was done in both uterine arteries. Maternal and neonatal outcomes in women with abnormal and normal Doppler results were compared. RESULTS Abnormal Doppler results were present in 45 women (75%). Thirty-four (56.7%) women had abnormal RI, 19 (31.6%) had abnormal PI, and 36 (60%) had diastolic notch. Of the women who participated in the study, 21.6% developed maternal complications, and the majority belonged to the early-onset severe preeclampsia group. Diastolic notch was twofold more frequent in the early group. RI was abnormal in 63% of the early-onset and 50% of the late-onset group. CONCLUSION Pregnancies with early-onset preeclampsia who had abnormal uterine artery Doppler findings were at high risk for both maternal and neonatal complications, whereas those who had late-onset preeclampsia with abnormal Doppler findings only had an increased risk of perinatal complications.
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Affiliation(s)
- Keerthi Chilumula
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Pradip Kumar Saha
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Tanuja Muthyala
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Subhas Chandra Saha
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Venkataseshan Sundaram
- Department of Neonatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vanita Suri
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Maged AM, Shoab AY, Hussein EA, Alsawaf AH, Mahmoud DS, AbdAllah AA, Dahab S, Darwish M, Ali YZ, Badran H. The Effect of Antenatal Vaginal Progesterone Administration on Uterine, Umbilical, and Fetal Middle Cerebral Artery Doppler Flow: A Cohort Study. Am J Perinatol 2020; 37:491-496. [PMID: 30866028 DOI: 10.1055/s-0039-1683438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effect of vaginal progesterone (P) administration during the second and third trimesters of pregnancy on Doppler velocimetry of uterine, umbilical, and middle cerebral vessels. STUDY DESIGN A prospective cohort study conducted on 80 women at risk for preterm labor. Uterine artery, umbilical artery, and middle cerebral artery (MCA) Doppler indices were measured before and after 1 week of administration of 200 mg twice daily vaginal P. The primary outcome parameter was the change of MCA pulsatility index (PI) after P administration. Secondary outcomes included changes in uterine artery and umbilical artery Doppler measurement. RESULTS There was no significant changes of umbilical artery resistance index (RI) (0.69 ± 0.049 vs. 0.68 ± 0.041), umbilical artery PI (1.14 ± 0.118 vs. 1.11 ± 0.116), uterine artery RI (0.66 ± 0.12 vs. 0.66 ± 0.107), uterine artery PI (1.00 ± 0.26 vs. 1.016 ± 0.24), and MCA PI (1.27 ± 0.18 vs. 1.26 ± 0.23) measurements before and after 1 week of P administration, respectively. CONCLUSION Administration of vaginal P has no significant effects on uterine artery, umbilical artery, and MCA Doppler indices.
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Affiliation(s)
- Ahmed M Maged
- Department of Obstetrics and Gynecology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Amira Y Shoab
- Department of Obstetrics and Gynecology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Eman A Hussein
- Department of Obstetrics and Gynecology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Ahmed H Alsawaf
- Department of Obstetrics and Gynecology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Doaa S Mahmoud
- Department of Obstetrics and Gynecology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Ameer A AbdAllah
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Sherif Dahab
- Department of Obstetrics and Gynecology, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | - Mohamed Darwish
- Department of Gynecology and Obstetrics, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Yahia Z Ali
- Department of Gynecology and Obstetrics, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Haitham Badran
- Department of Gynecology and Obstetrics, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Maged AM, Elsherief A, Hassan H, Salaheldin D, Omran KA, Almohamady M, Dahab S, Fahmy R, AbdelHak A, Shoab AY, Lotfy R, Lasheen YS, Nabil H, Elbaradie SMY. Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management. J Matern Fetal Neonatal Med 2020; 33:314-321. [PMID: 29914278 DOI: 10.1080/14767058.2018.1491030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To assess the relationship between maternal, fetal, and neonatal outcomes and different forms of hypertensive disorders associating pregnancy in women needed intensive care units (ICUs) admission.Methods: A prospective case control study was conducted on 1238 women admitted to hypertensive ICU at three university hospitals. They were classified into four groups. Group I included 472 women with severe preeclampsia (PE), Group II included 243 women with eclampsia (E), Group III included 396 women diagnosed with E associated with HELLP syndrome, and Group IV included 127 women diagnosed as HELLP syndrome. All women received magnesium sulfate to prevent and/or control convulsions and nifedipine to control their blood pressure. Primary outcome parameter was maternal mortality. Other outcomes included maternal morbidities, fetal, and neonatal outcomes.Results: There was a significant difference among the study groups regarding the need for blood transfusion (58.1%, 70%, 84.3%, and 42.5% respectively, p < .001), number of transferred units (2.4 ± 1, 2.9 ± 0.9, 3.4 ± 1.1, and 3.5 ± 0.8 respectively, p < .001), placental abruption (23.3%, 16.5%, 30.3%, and 19.7% respectively, p < .001), pulmonary edema (14.8%, 22.6%, 19.9%, and 34.6% respectively, p < .001), multiple complications (12.5%, 12.3%, 19.9%, and 26% respectively, p < .001), and maternal mortality (1.9%, 4.1%, 6.1%, and 5.5% respectively, p < .001). Regarding fetal and neonatal outcomes, there was a significant difference among the four groups regarding Apgar score at 1 and 5 min, neonatal birth weight, neonatal intensive care unit (NICU) admission, NICU admission days, intrauterine growth restriction, perinatal death, respiratory distress syndrome, intraventricular hemorrhage, sepsis, and the need for mechanical ventilation (p < .001). Higher rate of vaginal delivery was reported in women with HELLP (40.9%) and severe PE (39.8%) and higher rates of performing cesarean section (CS) in women with eclampsia (77.8%). Maternal mortality is significantly related to delivery with CS, younger maternal age with lower parity, and the presence of placental abruption or pulmonary edema. For Groups III and IV, which included HELLP cases, there are significant differences between both groups as regards HELLP classes according to Mississippi classification, also significant differences were seen between both groups as regards, maternal mortality, abruptio placenta, pulmonary edema, multiple organ damage, NICU admission, perinatal deaths, and need for mechanical ventilation.Conclusion: Both maternal mortality and morbidity (placental abruption and need for blood transfusion) are significantly higher in women with HELLP syndrome worsens to become class 1 regardless of whether eclampsia is present or not.Synopsis: Maternal mortality and unfavorable outcome are significantly higher in women with HELLP syndrome whether it was associated with eclampsia or not.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Ameer Elsherief
- Obstetrics and Gynecology Department, Minya University, Minya, Egypt
| | - Hany Hassan
- Obstetrics and Gynecology Department, Minya University, Minya, Egypt
| | - Doaa Salaheldin
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Khaled A Omran
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Maged Almohamady
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Sherif Dahab
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Radwa Fahmy
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Ahmed AbdelHak
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Amira Y Shoab
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Rehab Lotfy
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Yossra S Lasheen
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
| | - Hala Nabil
- Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt
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Maged AM, Shoab AY, Dieb AS. Antepartum and postpartum uterine artery impedance in women with pre-eclampsia: a case control study. J OBSTET GYNAECOL 2019; 39:633-638. [DOI: 10.1080/01443615.2018.1563054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ahmed M. Maged
- Department of Obstetrics and Gynecology, KasrAlAini Hospital Cairo University, Cairo, Egypt
| | - Amira Y. Shoab
- Department of Obstetrics and Gynecology, KasrAlAini Hospital Cairo University, Cairo, Egypt
| | - Amira S. Dieb
- Department of Obstetrics and Gynecology, KasrAlAini Hospital Cairo University, Cairo, Egypt
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Combined use of serum MCP-1/IL-10 ratio and uterine artery Doppler index significantly improves the prediction of preeclampsia. Clin Chim Acta 2017; 473:228-236. [DOI: 10.1016/j.cca.2016.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/26/2016] [Accepted: 12/26/2016] [Indexed: 12/18/2022]
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Maged AM, Saad H, Meshaal H, Salah E, Abdelaziz S, Omran E, Deeb WS, Katta M. Maternal serum homocysteine and uterine artery Doppler as predictors of preeclampsia and poor placentation. Arch Gynecol Obstet 2017; 296:475-482. [PMID: 28689278 DOI: 10.1007/s00404-017-4457-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the role of maternal serum total Homocysteine (tHcy) and uterine artery (Ut-A) Doppler as predictors of preeclampsia (PE), intrauterine growth restriction (IUGR), and other complications related to poor placentation. PATIENTS AND METHODS A prospective cohort study was conducted on 500 women with spontaneous pregnancies. tHcy was measured at 15-19 weeks, and then, Ut-A Doppler was performed at 18-22 weeks of pregnancy. RESULTS 453 pregnant women completed the follow-up of the study. The tHcy and Ut-A resistance index were significantly higher in women who developed PE, IUGR, and other complications when compared to controls (tHcy: 7.033 ± 2.744, 6.321 ± 3.645, and 6.602 ± 2.469 vs 4.701 ± 2.082 μmol/L, respectively, p value <0.001 and Ut-A resistance index: 0.587 ± 0.072, 0.587 ± 0.053, and 0.597 ± 0.069 vs 0.524 ± 0.025, respectively, p value <0.001). The use of both tHcy assessment and Ut-A Doppler improved the sensitivity of prediction of PE relative to the use of each one alone (85.2 relative to 73.33 and 60%, respectively). CONCLUSION The use of elevated homocysteine and uterine artery Doppler screening are valuable in prediction of preeclampsia, IUGR, and poor placentation disorders. CLINCALTRIAL. GOV ID NCT02854501.
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Affiliation(s)
- Ahmed M Maged
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt.
| | - Hany Saad
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Hadeer Meshaal
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Emad Salah
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Suzy Abdelaziz
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Eman Omran
- Obstetrics and Gynecology Department, Cairo University, 135 King Faisal St. Haram, Giza, 12151, Egypt
| | - Wesam S Deeb
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Maha Katta
- Department of Obstetrics and Gynecology, Faculty of Medicine, BeniSuef University, Beni Suef, Egypt
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Maged AM, Abdelaal H, Salah E, Saad H, Meshaal H, Eldaly A, Katta MA, Deeb WS. Prevalence and diagnostic accuracy of Doppler ultrasound of placenta accreta in Egypt. J Matern Fetal Neonatal Med 2017; 31:933-939. [DOI: 10.1080/14767058.2017.1303667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ahmed M. Maged
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hoda Abdelaal
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Emad Salah
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hany Saad
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Hadeer Meshaal
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Ashraf Eldaly
- Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt
| | - Maha A. Katta
- Department of Obstetrics and Gynecology, Beni-Suef University, Beni-Suef, Egypt
| | - Wesam S. Deeb
- Department of Obstetrics and Gynecology, Fayoum University, Fayoum, Egypt
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Maged AM, Aid G, Bassiouny N, Eldin DS, Dahab S, Ghamry NK. Association of biochemical markers with the severity of pre-eclampsia. Int J Gynaecol Obstet 2016; 136:138-144. [DOI: 10.1002/ijgo.12029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/17/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Ahmed M. Maged
- Department of Obstetrics and Gynecology; Kasr AlAiny Hospital; Cairo University; Cairo Egypt
| | - Gamal Aid
- Department of Obstetrics and Gynecology; Kasr AlAiny Hospital; Cairo University; Cairo Egypt
| | - Nehal Bassiouny
- Department of Obstetrics and Gynecology; Kasr AlAiny Hospital; Cairo University; Cairo Egypt
| | - Doaa S. Eldin
- Department of Obstetrics and Gynecology; Kasr AlAiny Hospital; Cairo University; Cairo Egypt
| | - Sherif Dahab
- Department of Obstetrics and Gynecology; Kasr AlAiny Hospital; Cairo University; Cairo Egypt
| | - Nevein K. Ghamry
- Department of Obstetrics and Gynecology; Kasr AlAiny Hospital; Cairo University; Cairo Egypt
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Tang P, Xu J, Xie BJ, Wang QM. Use of serum and urinary soluble sFlt-1 and PLGF in the diagnosis of preeclampsia. Hypertens Pregnancy 2016; 36:48-52. [PMID: 27834501 DOI: 10.1080/10641955.2016.1237642] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Preeclampsia (PE) is a disorder of pregnancy marked by hypertension and proteinuria with no known treatment aside from pregnancy termination. The pathogenesis of PE is poorly understood, but is thought to originate in the placenta. We assessed the value of measuring serum and urinary soluble deformylase-like tyrosine kinase receptor 1 (sFlt-1), a known target of placental factors, and placental growth factor (PLGF), a key placental signaling molecule, in the diagnosis of PE. METHODS Eighty patients with PE were classified as either exhibiting mild (44 cases) or severe (36 cases) symptoms of PE. Forty normal pregnant women were selected as controls. Serum and urinary PLGF and sFlt-1 levels, along with the ratio of sFlt-1 to PLGF, were compared across groups. RESULTS Serum and urinary sFlt-1 and sFlt-1/PLGF ratios in severe PE patients were significantly higher than those in the mild PE group, and measurements from mild PE patients were significantly higher than controls (all P values <0.01). The serum and urinary PLGF levels in severe PE patients were significantly lower than mild PE patients, and mild PE patients had significantly lower PLGF levels than controls (all P values <0.01). As expected, serum sFlt-1 and PLGF levels and ratios were highly correlated with urinary sFlt-1 and PLGF levels and ratios. CONCLUSIONS The severity of PE was closely correlated with these measurements, suggesting that they may be useful tools in the diagnosis and evaluation of PE.
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Affiliation(s)
- Ping Tang
- a Obstetrics Department , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
| | - Jing Xu
- b Department of Clinical Laboratory , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
| | - Bao-Jun Xie
- b Department of Clinical Laboratory , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
| | - Qi-Mei Wang
- a Obstetrics Department , The Second People's Hospital of Liaocheng City , Liaocheng, Shandong Province, P. R . China
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