INTRODUCTION
Preeclampsia (PE) is a severe multisystem condition characterized by hypertension and end-organ dysfunction. It complicates 2-8% of pregnancies (1) and is a leading cause of maternal and neonatal morbidity and mortality (2,3).
We can distinguish two entities in terms of pathophysiology, in one hand late-onset PE (developed after 34 weeks’ gestation) and in the other hand early-onset PE that is thought to be more related to placental insufficiency (4–6), which confers higher maternal and neonatal risks (3,7,8).
Expectant management improves neonatal outcome in selected cases of early-onset PE (9,10). Thus, clinical decisions are determined by a trade-off between reducing the risks of maternal complications by timely delivery and minimizing the risks of prematurity by expectant management. Therefore, a reliable prediction of maternal complications is essential in selecting women for expectant management. So far, even when multi-parametric risk-scoring is used, such prediction capacity is still moderate (11,12).
Maternal levels of angiogenic factors at admission for suspected PE have emerged as prognostic predictors, including placental growth factor [PlGF], soluble fms-like tyrosine kinase 1 [sFlt-1] and the sFlt-1/PlGF ratio. These factors have showed a good capacity in ruling out maternal complications and a moderate capacity in predicting its occurrence (13,14). In addition, they may predict the interval to delivery in suspected PE (15). It has been also suggested that longitudinal changes of the angiogenic factors levels may provide additional prediction capacity for the occurrence of complications in suspected PE (16). The performance of this capacity in women with confirmed PE has been less explored. Sequential angiogenic factors differences has been compared retrospectively between early and late-onset PE (17) or described prospectively in women admitted with mixed hypertensive disorders (18). However, the clinical value of the angiogenic factors longitudinal changes has not been specifically investigated in early-onset cases already meeting severity criteria, which is the clinical presentation with the greatest risk of maternal and fetal complications (19).
The objective of this study is to test in early-onset severe PE whether the longitudinal changes in maternal anigiogenic factors levels improve the prediction capacity of adverse outcome and time interval to delivery.