Diagnostic and predictive role of maternal circulating PlGF levels promising in reduced fetal movements, reveals study
Women presenting with reduced fetal movements (RFM) have an increased risk of adverse pregnancy outcomes and stillbirth. A study assessing the outcome of low-risk pregnancies complicated by isolated RFM at term, found that RFM were independently associated with mild adverse neonatal outcome and higher rates of cesarean de livery due to fetal distress and intrauterine fetal death at admission, compared to the group without RFM occurring prior to gestational week 37. The mechanisms for the association between maternal perception of RFM and stillbirth are not fully understood, but it is hypothesized that placental dysfunction could be a common pathology. In support of this hypothesis, a register-based retrospective cohort study of perinatal deaths found an association between RFM and placental insufficiency, defined as significant placental lesion(s) on pathological examination in cases with stillbirth.
Placenta-associated biomarkers, such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) are present in the maternal circulation during pregnancy. Imbalances in these biomarkers, with low “proangiogenic” PlGF concentrations and high“antiangiogenetic” sFlt-1 concentrations in maternal circulation, are associated with placenta-related pregnancy complications such as pre eclampsia and fetal growth restriction. Placentas from pregnancies with RFM presenting at gestational age (GA) > 36 weeks resulting in adverse delivery outcome have shown increased villous release of sFlt-1 compared to pregnancies without adverse delivery outcome.
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