Placental Growth Factor and Uterine-Artery Doppler for Prediction of Preeclampsia, Fetal Growth Restriction and Early Preterm Birth.

OBJECTIVES

To assess whether placental growth factor (PlGF) and uterine artery (UtA) Doppler measured at 20-28 weeks can predict preeclampsia (PE), fetal growth restriction or small for gestational age (FGR/SGA), and preterm birth before 34 weeks (PTB < 34 w).

METHODS

From December 2021 to January 2025, PlGF testing and UtA Doppler were offered prospectively between 20 and 28 weeks in a high-risk obstetric population. Low PlGF was defined as <5th percentile for gestational age. Abnormal UtA was defined as a mean pulsatility index >95th percentile or diastolic notching. PE, FGR/SGA, and PTB were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated.

RESULTS

Of 223 participants enrolled, 74 had both PlGF and UtA measurements. PE occurred in 14/74 (18.9%), FGR/SGA in 22/74 (29.7%), and PTB < 34 weeks in 19/74 (25.6%). PlGF alone detected PE with 71% sensitivity and 37% PPV, FGR/SGA with 68% sensitivity and 60% PPV, and PTB < 34 weeks with 68% sensitivity and 57% PPV. UtA alone had low sensitivity (45%-53%) and PPV (28%-53%). Low PlGF and/or abnormal UtA maximized sensitivity, 86% for PE, 68% for FGR/SGA, and 74% for PTB < 34 weeks, but reduced specificity (57%-60%). Low PlGF plus abnormal UtA improved PPV for FGR/SGA (77%) and PTB < 34 weeks (82%) but had limited sensitivity (36%-47%).

CONCLUSIONS

PlGF measurement alone showed superior predictive power for PE, FGR/SGA, and PTB < 34 weeks. UtA Doppler combined with PlGF enhanced sensitivity or raised PPV. Abnormal UtA without low PlGF provided minimal incremental detection.