INTRODUCTION
Preeclampsia (PE) is a pregnancy-related syndrome characterized by
hypertension and end-organ dysfunction that affects about 2-8% of
pregnancies (1). It is worldwide a leading cause of maternal morbidity
and mortality (2), and, accordingly, prediction and prevention of these
maternal complications have been the main research focus. In addition,
PE is also linked to neonatal complications mainly due to the associated
placental insufficiency and prematurity, being responsible for 10% of
stillbirths (3) and ranking first as a cause of iatrogenic prematurity
(4).
In terms of pathophysiology, two entities can be distinguished, on one
hand late-onset PE (developed after 34 weeks’ gestation) and on the
other hand early-onset PE, which is strongly associated with placental
insufficiency and maternal systemic endothelial damage confering the
highest maternal and neonatal risks (5–7). In addition, we can classify
the disease by the presence of severe features. This severity is defined
by laboratory and clinical parameters only from the maternal
compartment. Moreover, most of the multi-parametric risk-scores models,
such as Prediction of Risks in Early-onset Preeclampsia (PREP) and
Preeclampsia Integrated Estimate of Risk (PIERS) have shown promise in
the prediction of maternal but not neonatal outcomes (8,9).
Fetal and maternal Doppler has been proposed for predicting neonatal
adverse outcome, under the rationale that it may capture the
intrauterine stress secondary to the maternal disease. Despite that, in
the context of PE several studies have demonstrated that fetal Doppler
indices did not accurately predict neonatal outcomes (10–14) and that
the natural history of placental insufficiency is less predictable in
women with PE (15). Furthermore, Doppler ultrasound surveillance
requires trained staff and advanced equipment, which may not be
available in all settings.
In PE, the endothelial and placental dysfunction leads to increased
levels of anti-angiogenic factors (like soluble fms-like tyrosine
kinase-1 [s-Flt-1]) and decreased maternal levels of pro-angiogenics
factors (like placental growth factor [PlGF]) (16,17). These
biochemical markers seem to be helpful for the diagnosis of the disease
and have emerged as reliable predictors of adverse perinatal outcomes in
women with suspected PE (18–20), although it is not known its role in
predicting neonatal complications in women with an established diagnosis
of PE (21).
This study aims to assess the predictive value for adverse neonatal
outcomes at admission of Doppler ultrasound, angiogenic factors and
multi-parametric risk-score models in women with early-onset severe PE.