The correlation between serum levels and placental tissue expression of PLGF and sFLT-1 and the FIGO grading of the placenta accreta spectrum disorders

Figures & data

Table 1. Clinical characteristics of subjects with placenta previa totalis and with FIGO 1-3 PAS disorders.

Variable	Placenta previa (n = 20)	FIGO grade I (n = 10)	FIGO grade 2 (n = 8)	FIGO grade 3 (n = 22)	p
Characteristic
Maternal age (year)*	32 (27–41)	33,00 (27–38)	32,00 (30–38)	35,00 (22–44)	.0506
BMI (Kg/m^2)*	27,40 (20–44)	25,79 (23–34)	25,24 (19–32)	28,25 (22–50)	.255
Gravida*	3 (1–6)	4 (2–5)	3 (2–6)	3 (2–6)	.255
Delivery pregnancy week (week)*	37 (30–38)	36 (32–38)	36 (32–37)	36 (27–38)	.014
History of uterine operation* : no cs	5 (25%)	0	0	0	.032
Previous CS 1×	9 (45%)	3 (30%)	4 (50%)	8 (36,4%)
Previous CS 2×	6 (30%)	7 (70%)	4 (50%)	12 (54,5%)
Previous CS 3×	0	0	0	2 (9,1%)
Operation Procedure (n%)** : Cesarean section	20 (100%)	1 (10%)	0 (0)	0 (0)	.000
Uterine resective-reconstructive surgery	0 (0)	9 (90%)	7 (87,5%)	6 (27,3%)
Hysterectomy	0 (0)	0 (0)	1 (12,5%)	16 (72,2%)
Total blood loss (ml)*	450 (200–1500)	1200 (300–2500)	2100 (1000–4500)	2050 (1000–8000)	.000
Transfusion during surgery* PRBC (250cc/bag)	0 (0–2)	1,00 (0–4)	1,50 (0–4)	2,50 (1–8)	.000

PRBC: Packed Red Blood Cell; *Data presented as median (Min-Max); **Data presented as a number of sample; ***Statistical analysis using Kruskal–Wallis.

Table 2. Results of serum levels and expression of PLGF and sFlt-1 in placenta previa totalis, grade I, grade II and grade III.

Variable	Placenta previa (n = 20)	Grade I (n = 10)	Grade II (n = 8)	Grade III (n = 22)	p-Value
	Median (min–max)	Median (min–max)	Median (min–max)	Median (min–max)
Serum PLGF (pg/ml)*	233.69 (0.00–2343)	124.39 (10.42–663.68)	236.89 (18.83–418.99)	237.31 (2.26–3101)	0.736
Serum sFlt-1 (pg/ml)*	2816.50 (418–12925)	2506.00 (227.5–16104)	2494.50 (888.52–20812)	1601.00 (662.16–9574)	0,037
PLGF Expression*	4 (1–9)	4 (2–9)	4 (4–9)	6 (2–9)	0.001
sFLT-1 Expression*	6 (2–9)	6 (2–9)	4 (1–9)	4 (1–9)	0.004
Adjusted >34 weeks of GA	n = 20	n = 9	n = 6	n = 19
Serum PLGF (pg/ml)*	228.66 (0.01–2434)	124.39 (10.42–663.68)	236.89 (55.01–419)	238.24 (2.26–3101)	0.693
Serum sFlt-1 (pg/ml)*	2941 (418–12925)	2506 (227.50–16104)	2494.5 (1398–4642)	1695 (679–9574)	0.083
PLGF Expression*	4 (1–9)	4 (2–9)	5 (4–9)	6 (2–9)	0.003
sFLT-1 Expression*	6 (2–9)	4 (1–9)	4 (1–9)	4 (1–9)	0.014

Grade I, II dan III: grading FIGO Placenta Accreta Spectrum; PLGF: Placental growth factor; sFlt-1 : Soluble Fms-like tyrosin kinase 1. Data presented in median (min-max) & mean ± SD; *Statistical analysis using Kruskal–Wallis.

Figure 1. (A) sFlt-1 expression at 400x magnification in Placenta Previa. Percentage of cells 0-10% with weak intensity. Blue arrow indicates IHC stained in the villous trophoblast. Red arrow indicates the mesenchymal cell. Yellow arrow indicates the blood vessel in the placental villous. (B) Strong intensity of sFlt-1 expression of villous trophoblast (blue arrow) at 400x magnification in FIGO grade 3. Red arrow indicates the mesenchymal cell.

Figure 2. (A) PLGF expression at 200× magnification in Placenta Previa show weak intensity with percentage of cells 0-10%. Blue arrow indicates IHC stained in the villous trophoblast. Red arrow indicates the mesenchymal cell. Yellow arrow indicates the blood vessel in the placental villous. (B) Strong intensity of PLGF expression at 200x magnification in FIGO grade 3. Percentage of cells ≥ 50% with strong intensity of villous trophoblast (blue arrow). Red arrow indicates the mesenchymal cell. Yellow arrow indicates the blood vessel in the placental villous.