Changes in intrapartum maternal placental growth factor levels in pregnancies complicated by fetal compromise at term

Background: Intrapartum fetal compromise (IFC) may result from the gradual decline in placental function during labour and can precipitate adverse neonatal outcomes. Placental growth factor (PlGF) is a biomarker of placental function. This study aims to investigate maternal PlGF levels and adverse perinatal outcomes in term labour.

Methods: Prospective observational study (Mater Mothers' Hospital, Brisbane). Eligibility: 37⁺⁰- 42⁺⁰ weeks gestation, singleton, cephalic, non-anomalous pregnancies. Cases of pre-eclampsia and fetal growth restriction were excluded. Maternal PlGF was sampled at the onset of the first stage of labour (1st PlGF) and again at the second stage (2nd PlGF).

Results: Sixty-three participants met inclusion criteria. Women requiring operative delivery (n = 11) for IFC had lower 1st PlGF (90.8 vs. 111.8 pg/ml) and 2nd PlGF (65.8 vs. 83.7 pg/ml) compared to the no-IFC cohort (n = 52). PlGF levels decreased significantly during labour in both the IFC (90.8 vs. 65.8 pg/ml, p = 0.021) and no-IFC (111.8 v 83.7, p < 0.001) cohorts, although the decline in PlGF levels was greater in the IFC cohort (-41.8% vs. -23.4%, p = 0.385). Maternal PlGF levels were significantly lower in those with an abnormal fetal heart rate pattern, cord arterial pH < 7.2, nursery admission and composite adverse neonatal outcome (CANO). PlGF decline was not correlated to duration of labour but was influenced by nulliparity and induced labour.

Conclusions: Maternal PlGF levels are lower in pregnancies complicated by IFC and CANO, and declines more sharply during labour compared to the no-IFC cohort. The utility of PlGF as a predictor of IFC should be further investigated with clinical trials.