EP12.03: Circulating angiogenic factors levels in women with hypertensive disorders of pregnancy according to the baseline hemodynamic findings

To assess in women with hypertensive disorders of pregnancy (HDP) if the predictive value of sFLT-1/PlGF ratio for adverse outcomes is influenced by the hemodynamic phenotype. Retrospective study including a cohort of women with new-onset HDP carrying a singleton viable pregnancy from 22 to 36 gestational weeks. A non-invasive assessment of the main maternal hemodynamic parameters [Cardiac Output (CO), Systemic Vascular Resistance (SVR)] was done upon hospital admission using USCOM-1A. The hemodynamic phenotype was classified as “hypodynamic” in case of low CO[<5L/min] and/or high SVR [>1400 dynes*s*cm-5] or as “non-hypodynamic” in case of normal or high CO [>5 L/min] and/or low SVR [<1400 dynes*s*cm-5]. The values of sFLT-1 and PlGF were assessed on maternal serum upon hospital admission and their ratio was calculated. An adverse composite maternal outcome (ACMO) was defined in presence of at least one among: severe hypertension or placental abruption or occurrence of end-organ dysfunction as defined by ISSHP guidelines 2021. A composite of adverse neonatal outcome (ACNO) included birthweight below the 10th percentile (small for gestational age), or fetal/neonatal death. Among the 93 women included, 57 (61.2%) were categorised as hypodynamic and 36 (38.8%) as non-hypodynamic. sFLT-1/PLFG ratio at admission was significantly higher in the former group compare with the latter (301[93.1-787] vs. 52.5 [10.0-257.0]). A significant association between SFLT-1/PLGF ratio and an ACMO (p = 0.02) and an ACNO (p = 0.007) was reported only in the group of women defined with a “hypodynamic” profile. sFLT1/PlGF ratio is associated with the occurrence of an adverse maternal and neonatal outcome only in women with a hypodynamic profile.