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      The sFlt-1/PlGF Ratio Trend Is Useful in Predicting Preeclampsia Severity in Hyperreactio Luteinalis Complicated with Preeclampsia

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          Abstract

          Hyperreactio luteinalis (HL) is a rare condition that presents as bilateral ovarian enlargement during pregnancy. Typically, it is thought to be caused by increased production of human chorionic gonadotropin (hCG) associated with gestational trophoblastic diseases or multiple pregnancies. The prognosis is relatively good, with many cases resulting in term birth. However, some obstetric complications, such as preeclampsia (PE) and preterm births, have been reported. We present a serious case of HL with subsequent PE that resulted in preterm delivery at 31 weeks of gestation. The soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio was very high at the onset of PE at 24 weeks of gestation, followed by a modest decline, which then increased in proportion to the exacerbation of symptoms. Since HL cases have also been reported to be associated with PE, repeated measurement of the sFlt-1/PlGF ratio proved useful for better pregnancy management.

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          Competing risks model in screening for preeclampsia by serum placental growth factor and soluble fms-like tyrosine kinase-1 at 30-33 weeks' gestation.

          To assess the risk for preeclampsia (PE) by maternal characteristics, serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) at 30-33 weeks' gestation.
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            Hyperreactio luteinalis: timely diagnosis minimizes the risk of oophorectomy and alerts clinicians to the associated risk of placental insufficiency.

            Hyperreactio luteinalis (HL) is a rare benign condition complicating pregnancy with multicystic bilateral ovarian enlargement, increased serum βhCG levels and spontaneous regression after delivery. HL has been associated with complications of pregnancy and the aim of our research was to review the literature, and add a new unpublished case from our group. We searched the internet-based medical databases for case reports and case series of hyperreactio luteinalis and we evaluated diagnostic path, treatment and outcome of pregnancies. We found 96 cases of HL from 1955 to 2013. HL was asymptomatic in 28% of cases but in 72% of patients there were symptoms like lower abdominal pain, nausea and vomiting, ascites and signs of virilization. Suspicion of malignancy was raised in 38% of cases. Surgical treatment of various types was performed in 48% of cases, with oophorectomy in 40% of this group. Several complications were associated with HL, in particular preeclampsia (PE) occurred in 24% of cases and fetal growth restriction (FGR) in 12%. Mean gestation at delivery was 35 weeks (range 25-42). Although preoperative diagnosis occurred in most cases, suspicion of malignancy was extensive, as was oophorectomy, demonstrating suboptimal understanding of the underlying physiopathology. We propose a diagnostic algorithm for this condition. Training of obstetricians in making the correct diagnosis may prevent unnecessary oophorectomies and may lead to early diagnosis and correct management of associated complications.
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              Course of the sFlt-1/PlGF ratio in fetal growth restriction and correlation with biometric measurements, feto-maternal Doppler parameters and time to delivery

              Purpose The study aimed to assess the course of the soluble Fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio in pregnant women with fetal growth restriction (FGR) and to evaluate potential associations between the sFlt-1/PlGF ratio and feto-maternal Doppler parameters, fetal biometric measurements and the time between study inclusion and birth (“time to delivery”). Methods This was a retrospective longitudinal single center study including 52 FGR cases. The serum levels of sFlt-1 and PlGF were measured by using the BRAHMS Kryptor Compact PLUS. Fetal biometric and Doppler parameters, as well as the sFlt-1/PlGF ratio, were obtained both upon study inclusion and upon birth. Results Various associations between the levels of the biomarkers in maternal blood upon study inclusion and upon birth and sonographic parameters were observed in FGR cases: umbilical artery ( p  < 0.01), uterine arteries ( p  < 0.01), ductus venosus ( p  < 0.05), cerebroplacental ratio (CPR) ( p  < 0.01), femur length ( p  < 0.01) and birth weight ( p  < 0.01). The higher the sFlt-1/PlGF ratio upon study inclusion, the shorter the “time to delivery” ( p  < 0.01). The multivariate regression analysis showed that the greater the daily percentage increase of the angiogenic markers, the shorter the “time to delivery” ( p  < 0.01). Conclusion The fetal well-being, as measured by feto-maternal Doppler parameters such as CPR and the severity of the placental dysfunction, as measured by the urgency of birth and birth weight, is reflected by the level of the sFlt-1/PlGF ratio in the maternal serum. A rapid daily increase of the sFlt-1/PlGF ratio is significantly associated with the clinical progression of the disease.
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                Author and article information

                Contributors
                Journal
                Case Rep Obstet Gynecol
                Case Rep Obstet Gynecol
                CRIOG
                Case Reports in Obstetrics and Gynecology
                Hindawi
                2090-6684
                2090-6692
                2023
                19 September 2023
                : 2023
                : 7352947
                Affiliations
                1Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 113-8655, Japan
                2Department of Obstetrics and Gynecology, National Center for Child Health and Development, 157-8535, Japan
                3Department of Obstetrics and Gynecology, International University of Health and Welfare, 286-0124, Japan
                Author notes

                Academic Editor: Seung-Yup Ku

                Author information
                https://orcid.org/0000-0002-6330-2861
                https://orcid.org/0000-0003-0413-1238
                https://orcid.org/0000-0003-0865-604X
                https://orcid.org/0000-0002-2974-9109
                https://orcid.org/0000-0002-0509-7812
                https://orcid.org/0000-0003-0244-6332
                https://orcid.org/0000-0002-3030-4713
                https://orcid.org/0000-0001-7970-6695
                https://orcid.org/0000-0003-1480-5785
                https://orcid.org/0000-0002-6660-1066
                Article
                10.1155/2023/7352947
                10522418
                37766910
                02311c20-8596-49c3-9e4a-d2d2af3b2854
                Copyright © 2023 Risa Miyatake et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 January 2023
                : 3 May 2023
                : 18 August 2023
                Funding
                Funded by: Japan Society for the Promotion of Science
                Award ID: 20K09613
                Categories
                Case Report

                Obstetrics & Gynecology
                Obstetrics & Gynecology

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