Analysis of Maternal Serum PLGF, VEGF, and sFlt-1 in Placenta Accreta Spectrum and Normal Pregnancy

<ns3:p>Background Placenta Accreta Spectrum (PAS) is a severe obstetric condition characterized by abnormal placental trophoblast invasion into the myometrium, leading to significant maternal morbidity and mortality. While imaging remains the cornerstone of prenatal diagnosis, limitations in sensitivity and availability necessitate the exploration of adjunctive biomarkers. Dysregulation of angiogenic pathways has been implicated in PAS pathogenesis. To evaluate maternal serum levels of angiogenic biomarkers—placental growth factor (PlGF), vascular endothelial growth factor (VEGF), and soluble fms-like tyrosine kinase-1 (sFlt-1)—and to compare their expression between PAS and normal pregnancies. Methods This prospective case–control study was conducted at RSUP Dr. M. Djamil Padang between March and November 2025. Eighty-eight pregnant women were enrolled, comprising 44 PAS cases and 44 gestational age–matched controls with normal placentation. Maternal serum samples were collected at 32–34 weeks of gestation and analyzed for PlGF, VEGF, and sFlt-1 using enzyme-linked immunosorbent assay (ELISA). Demographic, obstetric, ultrasound, laboratory, and neonatal data were recorded. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p &lt; 0.05 considered statistically significant. Results Maternal demographic characteristics, fetal biometric parameters, neonatal outcomes, and baseline biochemical profiles were comparable between groups. Median maternal serum PlGF and VEGF levels were significantly lower in the PAS group compared with controls (PlGF: 3.825.660 vs 4.086.680 pg/mL, p = 0.032; VEGF: 8.713.645 vs 12.524.675 pg/mL, p = 0.008). Although sFlt-1 levels showed a decreasing trend in PAS cases, the difference was not statistically significant (p = 0.102). Alpha-fetoprotein (AFP) levels did not differ significantly between groups (p = 0.114). Conclusion PAS is associated with significant reductions in maternal serum PlGF and VEGF, reflecting angiogenic dysregulation and abnormal placental invasion. These biomarkers may serve as complementary tools to imaging modalities for improving prenatal detection of PAS. Larger studies are warranted to validate their clinical utility and integration into diagnostic algorithms.</ns3:p>