Z Geburtshilfe Neonatol 2021; 225(03): 232-237
DOI: 10.1055/a-1475-5413
Original Article

Maternal Serum Placental Protein-13 Levels in the Prediction of Pregnancies with Abnormal Invasive Placentation

Banuhan Şahin
1   Department of Gynecology and Obstetrics, Amasya University, Amasya, Turkey
,
Uğur Turhan
2   Department of Gynecology and Obstetrics, Private Perinatology Clinic, Samsun, Turkey
,
Buğra Şahin
3   Department of Gynecology and Obstetrics, Turhal State Hospital, Tokat, Turkey
,
İsmail Dağ
4   Department of Biochemistry, Eyüp State Hospital, İstanbul, Turkey
,
Andrea Tinelli
5   Department of Obstetrics and Gynecology, Veris delli Ponti Hospital, Scorrano, Lecce, Italy, Lecce, Italy
› Author Affiliations

Abstract

Objective To evaluate whether placental protein-13 (PP-13) measured in the serum of pregnant women could predict abnormal invasive placentation (AIP) detected by color Doppler ultrasound (US) and magnetic resonance imaging scan in addition to the routine US scan during the third trimester.

Materials and methods The prospective case-control study included patients subdivided in 2 groups: 42 pregnant women with a singleton pregnancy at 28–32 weeks of gestation with only suspected AIP, and 32 healthy pregnant women. The serum PP-13 levels were measured in both groups using an enzyme-linked immunosorbent assay (ELISA) method and statistically compared. The cases of AIP were confirmed by placental histopathological examination and/or the uterus removed by hysterectomy after elective caesarean section.

Results Serum PP-13 levels of pregnant women with AIP were significantly higher (p<0.001) than those of controls (650.32±387.33 vs. 231.43±94.33). Statistical analysis of maternal serum PP-13 levels above the threshold of 312 pg/ml (measured in the early third trimester) predicted AIP with 76.2% sensitivity and 75% specificity.

Conclusion Maternal serum PP-13 may have a role in the pathophysiology of AIP owing to its high serum value in the AIP group. The maternal serum dosage of PP-13 levels could improve pregnancy management in those patients suspected of having AIP.



Publication History

Received: 02 February 2021

Accepted after revision: 23 March 2021

Article published online:
05 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Papanikolaou IG, Domali E, Daskalakis G. et al. Abnormal placentation: current evidence and review of the literature. Eur J Obstet Gynecol Reprod Biol 2018; 228: 98-105
  • 2 Collins SL, Alemdar B, van Beekhuizen HJ. et al. Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol 2019; 220: 511-526
  • 3 Ernst LM, Linn RL, Minturn L. et al. Placental pathologic associations with morbidly adherent placenta: potential insights into pathogenesis. Pediatr Dev Pathol 2017; 20: 387-393
  • 4 Royal College of Obstetricians and Gynaecologists. Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. Green-top Guideline No. 27. London: RCOG; 2011
  • 5 Fitzpatrick KE, Sellers S, Spark P. et al. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG 2014; 121: 62-71
  • 6 Koai E, Hadpawat A, Gebb J. et al. Clinical outcomes of anterior compared with posterior placenta accreta. Obstet Gynecol 2014; 123: 60
  • 7 Parra-Herran C, Djordjevic B. Histopathology of placenta creta: chorionic villi intrusion into myometrial vascular spaces and extravillous trophoblast proliferation are frequent and specific findings with implications for diagnosis and pathogenesis. Int J Gynecol Pathol 2016; 35: 497-508
  • 8 Bartels HC, Postle JD, Downey P. et al. Placenta accreta spectrum: a review of pathology, molecular biology, and biomarkers. Dis Markers 2018; 2018: 1507674
  • 9 Burger O, Pick E, Zwickel J. et al. Placental protein 13 (PP-13): effects on cultured trophoblasts, and its detection in human body fluids in normal and pathological pregnancies. Placenta 2004; 25: 608-622
  • 10 Than NG, Balogh A, Romero R. et al. Placental protein 13 (pp13) – a placental immunoregulatory galectin protecting pregnancy. Front Immunol 2014; 5
  • 11 Chafetz I, Kuhnreich I, Sammar M. et al. First-trimester placental protein 13 screening for preeclampsia and intrauterine growth restriction. Am J Obstet Gynecol 2007; 197: 35
  • 12 Sammar M, Dragovic R, Meiri H. et al. Reduced placental protein 13 (PP13) in placental derived syncytiotrophoblast extracellular vesicles in preeclampsia – a novel tool to study the impaired cargo transmission of the placenta to the maternal organs. Placenta 2018; 66: 17-25
  • 13 Huppertz B, Sammar M, Chefetz I. et al. Longitudinal determination of serum placental protein 13 during development of preeclampsia. Fetal Diagn Ther 2008; 24: 230-236
  • 14 Farina A, Bernabini D, Zucchini C. et al. Elevated maternal placental protein 13 serum levels at term of pregnancy in postpartum major hemorrhage (>1000 mLs). A prospective cohort study. Am J Reprod Immunol 2017; 78: 10
  • 15 Biberoglu E, Kirbas A, Daglar K. et al. Serum angiogenic profile in abnormal placentation. J Matern Fetal Neonatal Med 2016; 29: 3193-3197
  • 16 Akolekar R, Pérez Penco JM, Skyfta E. et al. Maternal serum placental protein 13 at eleven to thirteen weeks in chromosomally abnormal pregnancies. Fetal Diagn Ther 2010; 27: 72-77
  • 17 Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am 2015; 42: 381-402
  • 18 Dighe MMR. Imaging of abnormal placentation. Magn Reson Imaging Clin N Am 2017; 25: 601-610
  • 19 Vahanian SA, Vintzileos AM. Placental implantation abnormalities: a modern approach. Curr Opin Obstet Gynecol 2016; 28: 477-484
  • 20 Iacovelli A, Liberati M, Khalil A. et al. Risk factors for abnormally invasive placenta: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 33: 471-481
  • 21 Palacios-Jaraquemada JM. Diagnosis and management of placenta accreta. Best Pract Res Clin Obstet Gynaecol 2008; 22: 1133-1148
  • 22 Budorick NE, Figueroa R, Vizcarra M. et al. Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta. J Matern Fetal Neonatal Med 2017; 30: 2422-2427
  • 23 Sak S, Barut M, Incebiyik A. et al. Management of peripartum hysterectomies performed on patients with placenta percreta in a tertiary central hospital. J Matern Fetal Neonatal Med 2019; 32: 883-888
  • 24 Duzyj CM, Buhimschi IA, Laky CA. et al. Extravillous trophoblast invasion in placenta accreta is associated with differential local expression of angiogenic and growth factors: a cross-sectional study. BJOG 2018; 125: 1441-1448
  • 25 Shainker SA, Silver RM, Modest AM. et al. Placenta accreta spectrum: biomarker discovery using plasma proteomics. Am J Obstet Gynecol 2020; 223: 433
  • 26 Zhou J, Li J, Yan P. et al. Maternal plasma levels of cell-free β-HCG mRNA as a prenatal diagnostic indicator of placenta accrete. Placenta 2014; 35: 691-695
  • 27 Berezowsky A, Pardo J, Ben-Zion M. et al. Second trimester biochemical markers as possible predictors of pathological placentation: a retrospective case-control study. Fetal Diagn Ther 2019; 46: 187-192
  • 28 Li J, Zhang N, Zhang Y. et al. Human placental lactogen mRNA in maternal plasma play a role in prenatal diagnosis of abnormally invasive placenta: yes or no?. Gynecol Endocrinol 2019; 35: 631-634
  • 29 Booker W, Moroz L. Abnormal placentation. Semin Perinatol 2019; 43: 51-59
  • 30 Sammar M, Drobnjak T, Mandala M. et al. Galectin 13 (PP13) facilitates remodeling and structural stabilization of maternal vessels during pregnancy. Int J Mol Sci 2019; 20: 3192
  • 31 Than NG, Romero R, Kim CJ. et al. Galectins: guardians of eutherian pregnancy at the maternal-fetal interface. Trends Endocrinol Metab 2012; 23: 23-31
  • 32 Sekizawa A, Purwosunu Y, Yoshimura S. et al. PP13 mRNA expression in trophoblasts from preeclamptic placentas. Reprod Sci 2009; 16: 408-413
  • 33 Farina A, Zucchini C, Sekizawa A. et al. Performance of messenger RNAs circulating in maternal blood in the prediction of preeclampsia at 10–14 weeks. Am J Obstet Gynecol 2010; 203: 575
  • 34 Poon LC, Syngelaki A, Akolekar R. et al. Combined screening for preeclampsia and small for gestational age at 11–13 weeks. Fetal Diagn Ther 2013; 33: 16-27
  • 35 Meiri H, Osol G, Cetin I. et al. Personalized therapy against preeclampsia by replenishing placental protein 13 (PP13) targeted to patients with impaired PP13 molecule or function. Comput Struct Biotechnol J 2017; 15: 433-446
  • 36 Huppertz B, Meiri H, Gizurarson S. et al. Placental protein 13 (PP13): a new biological target shifting individualized risk assessment to personalized drug design combating pre-eclampsia. Hum Reprod Update 2013; 19: 391-405
  • 37 Kliman HJ, Sammar M, Grimpel YI. et al. Placental protein 13 and decidual zones of necrosis: an immunologic diversion that may be linked to preeclampsia. Reprod Sci 2012; 19: 16-30