Introduction 5% of women present with reduced fetal movements (RFM) in the third trimester and 20% of these will have poor pregnancy outcome defined as preterm birth <37 weeks, birthweight below the 5th centile or stillbirth. Currently, there are no sensitive and specific methods to accurately identify women who develop complications. We hypothesise that placentally-derived factors could be used as a potential screening tool for complications after RFM.
Methods 305 women experiencing RFM after 28 weeks gestation were recruited. Serum samples were taken at time of presentation and were analysed using ELISA for hCG, hPL, PAPP-A and LDH. Multiplex cytokine assay was performed on serum samples from a subset of women with RFM (40 with poor outcome and 40 with normal outcome).
Results In women with RFM and poor pregnancy outcome, there was a significant reduction in plasma concentrations of hCG (13041 vs 16926 IU/l; p<0.05) and hPL (311 vs 355 mg/l; p<0.0005), compared to those with RFM and normal outcome. In addition, pregnancies with poor outcomes had higher levels of tumour necrosis factor (30.2 vs 27.8 pg/ml; p<0.05) and lower levels of CXCL10 (p<0.01) in maternal serum. Women with hPL levels <1SD below the mean for gestation were more likely to have poor outcome following RFM (specificity 95%, sensitivity 30%).
Discussion This preliminary study suggests that placentally-derived factors may be useful markers for obstetric complications after RFM. In addition, dysregulation of such factors may provide clues to the underlying placental condition, such as inflammation or oxidative stress leading to altered hormonal or cytokine profile.
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