GLYCOSYLATED FIBRONECTIN AND SFLT-1/PLGF RATIO AS PREDICTORS OF EMERGENCY CAESAREAN DELIVERY AND INTRAPARTUM FOETAL DISTRESS IN WOMEN WITH SUSPECTED PREECLAMPSIA
GLYCOSYLATED FIBRONECTIN AND SFLT-1/PLGF RATIO AS PREDICTORS OF EMERGENCY CAESAREAN DELIVERY AND INTRAPARTUM FOETAL DISTRESS IN WOMEN WITH SUSPECTED PREECLAMPSIA

Summary/Abstract: Preeclampsia (PE) and other placentally mediated disorders of pregnancy result from endothelial dysfunction and angiogenic imbalance. Circulating biomarkers such as the soluble fms like tyrosine kinase 1/placental growth factor (sFlt 1/PlGF) ratio and glycosylated fibronectin (GlyFn) reflect placental stress and may predict adverse pregnancy outcomes. This study evaluated their ability to predict the need for emergency caesarean section and intrapartum foetal distress among women with suspected PE. In a prospective cohort, 129 pregnant women with singleton pregnancies and clinical suspicion of PE were enrolled at the University Clinic of Gynaecology and Obstetrics, Skopje (May 2024–May 2025). sFlt-1/PlGF ratio and GlyFn levels were measured at presentation. Patients were categorized as sFlt-1/PlGF ≥ 85 or < 85 and GlyFn ≥ 350 μg/mL or < 350 μg/mL. Outcomes included were mode of delivery, emergency caesarean, intrapartum foetal distress, need for induction, birthweight, and Apgar score ≤ 7. Logistic regression models were adjusted for gestational age at delivery. Elevated sFlt-1/PlGF (≥85) and GlyFn (≥350 μg/mL) were both associated with earlier delivery (median ≈ 33 weeks), lower birthweight, and higher rates of caesarean for foetal distress and low Apgar scores (all p < 0.001). After adjustment, sFlt-1/PlGF ≥ 85 predicted 2.6-fold higher odds of caesarean for foetal distress (OR 2.62; p = 0.039) and nearly ninefold higher odds of Apgar ≤ 7 (OR 8.88; p = 0.0015). GlyFn ≥ 350 μg/mL showed similar but weaker, nonsignificant trends. Both biomarkers identify pregnancies with placental dysfunction; however, the sFlt-1/PlGF ratio demonstrates stronger predictive value for intrapartum foetal distress and neonatal compromise. GlyFn may complement angiogenic profiling as a rapid point-of-care triage tool, but sFlt-1/PlGF provides superior prognostic information for delivery planning and surveillance.

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