The sFlt-1/PlGF ratio as a triage tool to identify superimposed preeclampsia in women with chronic hypertension in emergency rooms

OBJECTIVES

Assess the usefulness of the sFlt-1/PlGF ratio for the differential diagnosis of uncontrolled chronic hypertension vs. superimposed preeclampsia.

STUDY DESIGN

We performed a cross-sectional study from 2015 to 2017 and 42 women with initial diagnosis of superimposed preeclampsia were enrolled in the emergency room. After a 12 week follow up patients were grouped as superimposed preeclampsia (Group A) and uncontrolled chronic hypertension (Group B) according to the American College of Obstetricians and Gynecologist criteria. A group of 33 healthy women paired by gestational age were included as controls (Group C). Maternal serum levels of sFlt-1 and PlGF were measured at enrollment, and the ratios of the groups were compared.

MAIN OUTCOME MEASURES

Superimposed preeclampsia vs. uncontrolled chronic hypertension.

RESULTS

After follow-up, group distribution was 30 women in Group A, 12 women in Group B, and 25 women in Group C. The sFlt-1/PlGF ratio was higher in women with superimposed preeclampsia than in women with uncontrolled chronic hypertension (215.5 vs. 9.65, p < 0.001). The control group displayed lower ratio values (3.66, p < 0.001). The sFlt-1 concentration was higher in Group A than in Group B (7564 vs. 1281 pg/mL, p < 0.001) and the PlGF level was lower in Group A (34.39 vs. 169 pg/mL, p < 0.001).

CONCLUSIONS

The sFlt-1/PlGF ratio exhibits good performance for the differential diagnosis of superimposed preeclampsia vs. uncontrolled chronic hypertension.

[Takayasu's arteritis in pregnancy: report seven cases]

Takayasu's arteritis is a chronic and non-specific disease of young women in reproductive age that primarily affects the aorta, its branches and the pulmonary artery. Ramirez Cueto G. and Fernandez Del Castillo C. et al. published a case of pregnancy in Mexico and Takayasu's arteritis in 1968. There are no reports of this disease in pregnancy since. The purpose of this study is to describe the clinical course and perinatal outcome of seven pregnant patients with known diagnosis of Takayasu arteritis. The clinical course, laboratory findings, angiographic findings and perinatal outcomes were assessed in retrospect in seven pregnant patients with diagnosis of Takayasu's arteritis seen at the National Institute of Perinatology Isidro Espinosa Reyes (Mexico) during the period 2002-2010. The results of the conducted follow-up of 7 patients pregnant with Takayasu's arteritis were: 3 patients were complicated with pre-eclampsia and 2 newborn presented intrauterine growth restriction. Disease activity wasn't observed during pregnancy. No cases of congestive heart failure, brain ischemia or maternal deaths were presented. There were no fetal deaths. We didn't observed induced activity during pregnancy in the cases presented. The most common mother complication was type renovascular hypertension with added severe preeclampsia, which determined the presence of intrauterine growth restriction. There were no maternal or perinatal deaths.

[Acute toxicity by methotrexate used for abortion purpose. Case report]

We report the case of a 16 years old female patient, with a pregnancy history of 11.4 weeks by ultrasound and intrauterine fetal death. In a private clinic were prescribed methotrexate 500 mg intramuscular single dose, and vaginal misoprostol. She had a clinical feature of five days of evolution characterized by fever of 39 degrees C, nausea, general attack and vomiting. The initial diagnosis was severe sepsis secondary to septic abortion, oral candidiasis and acute poisoning by methotrexate. After that, she was referred to the Instituto Nacional de Perinatologia, where stayed with fever for four days, and was managed with hydration, antibiotics, folinic acid and alkalizing. Her recovery was gradual. She was discharged after 12 days with significant clinical improvement. The literature review describes that the use of methotrexate for abortion purpose with therapeutic-dose presents a similar adverse effects to those found in our patient, however there are no case reports that describe the use of this drug in macrodosis for the same purpose, and their cytotoxic effects. We present this case because the patient used a macrodosis of this antimetabolite and due to the premature and empirical management with folinic acid, joined with alkalinization of urine, is the ideal treatment and as it is illustrated in our case.