Generic placeholder image

Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Research Article

The Value of Serum Fibrinogen/Uric Acid Ratio as a Novel Marker of Fetal Growth Restriction in Preeclampsia at 34 Weeks

Author(s): Wassan Nori, Alaa Ibrahim Ali* and Wisam Akram Ismael

Volume 19, Issue 2, 2023

Published on: 02 June, 2022

Article ID: e010322201543 Pages: 6

DOI: 10.2174/1573404818666220301125216

Price: $65

Abstract

Background: Fetal growth restriction (FGR) is a common alignment that complicates pregnancy, especially for preeclampsia cases; therefore earlier detection is crucial to improve the outcome.

Objective: We examine whether the ratio of maternal serum fibrinogen to serum uric acid (ms F/U) can serve as a marker FGR in patients with preeclampsia at 34 weeks.

Material and Methods: A cross-sectional study recruited 98 preeclamptic primigravidae at the University Teaching Hospital from June 2018 to June 2019. Patients were sent for laboratory and ultrasound examinations. Maternal parameters include systolic and diastolic blood pressure, serum fibrinogen, and serum uric acid. Ultrasonic fetal parameters include amniotic fluid index AFI, estimated fetal weight EFW, pulsatility index PI, and resistance index RI.

Results: Pearson’s correlation between ms F/U ratio and all other feto-maternal variables was significant as P value was <0.0001. The ms F/U ratio showed strong positive correlations with EFW and AFI. The ms F/U ratio showed strong inverse correlations with PI, RI, systolic, diastolic blood pressure, and albumin/creatinine ratio. The strength of association tested by a coefficient of Mallow showed the strongest association between ms F/U versus fetal weight. The highest Odd ratio for FGR was 45, associated with the ms F/U ratio. The cutoff value for ms F/U ratio was 26.08 mg/dL with an estimated sensitivity and specificity of 85% and 96.25%, respectively, with an AUC of 0.82.

Conclusion: Strong and significant correlation of ms F/U ratio with feto-maternal parameters at high sensitivity and specificity added to its simplicity, and cost-effectiveness makes ms F/U ratio a reliable marker for earlier FGR to improve the outcome.

Keywords: Fetal growth restriction, marker, preeclampsia, serum uric acid, serum fibrinogen, serum fibrinogen per uric acid ratio.

Graphical Abstract

[1]
Nardozza, L.M.; Caetano, A.C.; Zamarian, A.C.; Mazzola, J.B.; Silva, C.P.; Marçal, V.M.; Lobo, T.F.; Peixoto, A.B.; Araujo, J. ْnior, E. Fetal growth restriction: Current knowledge. Arch. Gynecol. Obstet., 2017, 295(5), 1061-1077.
[http://dx.doi.org/10.1007/s00404-017-4341-9] [PMID: 28285426]
[2]
Wassan, N.M.H.; Shallal, F.; Ali, B. Prediction of successful induction of labor using ultrasonic fetal parameters. Curr. Womens Health Rev., 2021, 17(1), e201221189952.
[http://dx.doi.org/10.2174/1573404817666210105151803]
[3]
Gordijn, S.J.; Beune, I.M.; Thilaganathan, B.; Papageorghiou, A.; Baschat, A.A.; Baker, P.N.; Silver, R.M.; Wynia, K.; Ganzevoort, W. Consensus definition of fetal growth restriction: A Delphi procedure. Ultrasound Obstet. Gynecol., 2016, 48(3), 333-339.
[http://dx.doi.org/10.1002/uog.15884] [PMID: 26909664]
[4]
Tan, M.Y.; Wright, D.; Syngelaki, A.; Akolekar, R.; Cicero, S.; Janga, D.; Singh, M.; Greco, E.; Wright, A.; Maclagan, K.; Poon, L.C.; Nicolaides, K.H. Comparison of diagnostic accuracy of early screening for pre-eclampsia by NICE guidelines and a method combining maternal factors and biomarkers: Results of SPREE. Ultrasound Obstet. Gynecol., 2018, 51(6), 743-750.
[http://dx.doi.org/10.1002/uog.19039] [PMID: 29536574]
[5]
Nori, W.; Abdulghani, M.; Roomi, A.B. To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion. Clin. Exp. Obstet. Gynecol., 2021, 48(1), 168-174.
[http://dx.doi.org/10.31083/j.ceog.2021.01.2215]
[6]
Griffin, M.; Heazell, A.E.P.; Chappell, L.C.; Zhao, J.; Lawlor, D.A. The ability of late pregnancy maternal tests to predict adverse pregnancy outcomes associated with placental dysfunction (specifically fetal growth restriction and pre-eclampsia): A protocol for a systematic review and meta-analysis of prognostic accuracy studies. Syst. Rev., 2020, 9(1), 78.
[http://dx.doi.org/10.1186/s13643-020-01334-5] [PMID: 32268905]
[7]
Sun, C.; Groom, K.M.; Oyston, C.; Chamley, L.W.; Clark, A.R.; James, J.L. The placenta in fetal growth restriction: What is going wrong? Placenta, 2020, 96, 10-18.
[http://dx.doi.org/10.1016/j.placenta.2020.05.003] [PMID: 32421528]
[8]
Smith, G. A critical review of the Cochrane meta-analysis of routine late-pregnancy ultrasound. BJOG, 2021, 128(2), 207-213.
[http://dx.doi.org/10.1111/1471-0528.16386] [PMID: 32598533]
[9]
Elzein, H.O.; Muddathir, A.R.; Rida, M.; Rayis, D.A.; Elhassan, E.M.; Adam, I. Fibrinolysis parameters in Sudanese women with severe preeclampsia. Hypertens. Pregnancy, 2016, 35(4), 559-564.
[http://dx.doi.org/10.1080/10641955.2016.1211676] [PMID: 27598010]
[10]
Ryu, A.; Cho, N.J.; Kim, Y.S.; Lee, E.Y. Predictive value of serum uric acid levels for adverse perinatal outcomes in preeclampsia. Medicine (Baltimore), 2019, 98(18), e15462.
[http://dx.doi.org/10.1097/MD.0000000000015462] [PMID: 31045822]
[11]
Fisher, S.J. Why is placentation abnormal in preeclampsia? Am. J. Obstet. Gynecol., 2015, 213(4)(Suppl.), S115-S122.
[http://dx.doi.org/10.1016/j.ajog.2015.08.042] [PMID: 26428489]
[12]
Ridder, A.; Giorgione, V.; Khalil, A.; Thilaganathan, B. Preeclampsia: The relationship between uterine artery blood flow and trophoblast function. Int. J. Mol. Sci., 2019, 20(13), 3263.
[http://dx.doi.org/10.3390/ijms20133263] [PMID: 31269775]
[13]
Yang, J.; Shang, J.; Zhang, S.; Li, H.; Liu, H. The role of the renin-angiotensin-aldosterone system in preeclampsia: Genetic polymorphisms and microRNA. J. Mol. Endocrinol., 2013, 50(2), R53-R66.
[http://dx.doi.org/10.1530/JME-12-0216] [PMID: 23369849]
[14]
Campbell, N.; LaMarca, B.; Cunningham, M.W., Jr The role of agonistic autoantibodies to the angiotensin II type 1 receptor (AT1-AA) in pathophysiology of preeclampsia. Curr. Pharm. Biotechnol., 2018, 19(10), 781-785.
[http://dx.doi.org/10.2174/1389201019666180925121254] [PMID: 30255752]
[15]
Haram, K.; Mortensen, J.H.; Mastrolia, S.A.; Erez, O. Disseminated intravascular coagulation in the HELLP syndrome: How much do we really know? J. Matern. Fetal Neonatal Med., 2017, 30(7), 779-788.
[http://dx.doi.org/10.1080/14767058.2016.1189897] [PMID: 27181089]
[16]
Erez, O.; Mastrolia, S.A.; Thachil, J. Disseminated intravascular coagulation in pregnancy: Insights in pathophysiology, diagnosis and management. Am. J. Obstet. Gynecol., 2015, 213(4), 452-463.
[http://dx.doi.org/10.1016/j.ajog.2015.03.054] [PMID: 25840271]
[17]
Stillman, I.E.; Karumanchi, S.A. The glomerular injury of preeclampsia. J. Am. Soc. Nephrol., 2007, 18(8), 2281-2284.
[http://dx.doi.org/10.1681/ASN.2007020255] [PMID: 17634433]
[18]
Khaliq, O.P.; Konoshita, T.; Moodley, J.; Naicker, T. The role of uric acid in preeclampsia: Is uric acid a causative factor or a sign of preeclampsia? Curr. Hypertens. Rep., 2018, 20(9), 80.
[http://dx.doi.org/10.1007/s11906-018-0878-7] [PMID: 29992361]
[19]
Moghaddas Sani, H.; Zununi Vahed, S.; Ardalan, M. Preeclampsia: A close look at renal dysfunction. Biomed. Pharmacother., 2019, 109, 408-416.
[http://dx.doi.org/10.1016/j.biopha.2018.10.082] [PMID: 30399576]
[20]
Janas, P. Radoń-Pokracka, M.; Nowak, M.; Staroń, A.; Wilczyńska, G.; Brzozowska, M.; Huras, H. Effect of oligohydramnios on the accuracy of sonographic foetal weight estimation in at term pregnancies. Taiwan. J. Obstet. Gynecol., 2019, 58(2), 278-281.
[http://dx.doi.org/10.1016/j.tjog.2019.01.020] [PMID: 30910153]
[21]
Brosnahan, G. Treatment of hypertension in chronic kidney disease: Does one size fit all? A narrative review from a nephrologist’s perspective. Curr. Hypertens. Rev., 2014, 10(3), 155-165.
[http://dx.doi.org/10.2174/1573402111666150108101104] [PMID: 25567505]
[22]
Adekanmi, A.J.; Roberts, A.; Akinmoladun, J.A.; Adeyinka, A.O. Uterine and umbilical artery doppler in women with pre-eclampsia and their pregnancy outcomes. Niger. Postgrad. Med. J., 2019, 26(2), 106-112.
[http://dx.doi.org/10.4103/npmj.npmj_161_18] [PMID: 31187750]
[23]
Nori, W.; Roomi, A.B.; Akram, W. Platelet indices as predictors of fetal growth restriction in Pre-eclamptic women. Rev. Latinoam. Hipertens., 2020, 15(4), 280-285.
[24]
Gaccioli, F.; Sovio, U.; Cook, E.; Hund, M.; Charnock-Jones, D.S.; Smith, G.C.S. Screening for fetal growth restriction using ultrasound and the sFLT1/PlGF ratio in nulliparous women: A prospective cohort study. Lancet Child Adolesc. Health, 2018, 2(8), 569-581.
[http://dx.doi.org/10.1016/S2352-4642(18)30129-9] [PMID: 30119716]
[25]
Kharb, S.; Tiwari, R.; Nanda, S. Pro- to anti-angiogenic ratio in preeclampsia. Curr. Womens Health Rev., 2019, 15(2), 137-142.
[http://dx.doi.org/10.2174/1573404814666180627164125]
[26]
Wang, L.; Matsunaga, S.; Mikami, Y.; Takai, Y.; Terui, K.; Seki, H. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption. J. Obstet. Gynaecol. Res., 2016, 42(7), 796-802.
[http://dx.doi.org/10.1111/jog.12988] [PMID: 27075198]
[27]
Laasanen, J.; Hiltunen, M.; Punnonen, K.; Mannermaa, A.; Heinonen, S. Fibrinogen and factor VII promoter polymorphisms in women with preeclampsia. Obstet. Gynecol., 2002, 100(2), 317-320.
[PMID: 12151156]
[28]
Schwedler, C.; Heymann, G.; Bukreeva, L.; Hoppe, B. Association of genetic polymorphisms of fibrinogen, factor XIII a-subunit and α2-antiplasmin with fibrinogen levels in pregnant women. Life (Basel), 2021, 11(12), 1340.
[http://dx.doi.org/10.3390/life11121340] [PMID: 34947871]
[29]
Mardani, M.; Teymouri, F.; Rezapour, M. Risk factors of preeclampsia among pregnant women in khorramabad (west of Iran). Curr. Womens Health Rev., 2020, 16(4), 313-317.
[http://dx.doi.org/10.2174/1573404816999200521094509]
[30]
Nori, W.; Ali, A.I. Maternal alpha-1-antitrypsin as a noval marker for growth restriction in pre-eclampsia. J. Obstet. Gynaecol. Res., 2021, 47(12), 4250-4255.
[http://dx.doi.org/10.1111/jog.15043] [PMID: 34571571]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy