Soluble FMS-Like Tyrosine Kinase-1: Role in placenta accreta spectrum disorder

Abstract

Background: Placenta accreta is a pregnancy condition where the placenta's blood vessels attach too deeply to the uterine wall. Incidence of placenta accreta  is increasingly seen today as the rate of cesarean section increases, however, the exact pathophysiology of this condition is still not fully understood. Soluble fms-like tyrosine kinase-1  (sflt-1) as a protein produced by the placenta was found to be decreased in placenta accreta, Therefore we aim  to see if  sfltsFlt-1 has a role in the development of placenta accreta. Methods: This study involved 40 samples from patients that had been diagnosed with placenta accreta spectrum disorder (case group), and 40 samples from patients with normal pregnancies (control group)  at Rumah Skit Umum Pusat H.Adam Malik (RSUP) Haji Adam Malik Medan, in Indonesia.  Diagnosis of placenta accreta syndrome was based on Placenta Accreta Spectrum  Score (PAS), and International Federation of Gynecology and Obstetrics  (FIGO) classification of placenta accreta spectrum disorder.Analyses  were performed by independent t-test, man Mann-Whitney U test, and Kruskal-Wallis analysis test, with a P-value <0.05  considered as statistically significant (95%CI). Results: Based on this study, we found that the sFlt-1 level in the case group was lower than the control group. Data analysis using the Kruskal-Wallis test showed that there was a difference in sFlt-1 levels in this study group (p = 0.02), which was further evaluated  with post hoc analysis using Mann. -Whitney U test. The results indicated that there were significant differences between the control and PAS 0, PAS1, and PAS 2 (p = 0.043; p = 0.002; p = 0.03). Conclusion: sFlt-1 levels decreased in placental invasive pregnancies compared to normal pregnancies, however, this still needs to be investigated further in a multi-center study, considering that sFlt-1 levels are also influenced by ethnicity and other conditions that cannot be excluded in this study.