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

Objective: This study aims to further explore the role of angiogenic vs anti-angiogenic factors in placenta accreta spectrum (PAS). Methods: This cohort study included all patients with placenta previa and placenta accreta spectrum (PAS) disorders undergoing surgery at Dr. Soetomo Hospital (Academic Hospital of Universitas Airlangga, Surabaya, Indonesia) from May to September 2021. Venous blood samples for PLGF and sFlt-1 were drawn immediately prior to surgery. Placental tissue samples were taken during surgery. The FIGO grading was diagnosed intraoperatively by an experienced surgeon and confirmed by the pathologist and followed by immunohistochemistry (IHC) staining. The sFlt-1 and PLGF serum were performed by an independent laboratory technician. Results: Sixty women were included in this study (20 women with placenta previa; 10 women with FIGO PAS grade 1; 8 women with FIGO PAS grade 2; 22 women with FIGO PAS grade 3). The median with 95% Confidence interval of PLGF serum values in placenta previa, FIGO grade I, grade II, and grade III were 233.68 (0.00–2434.00), 124.39 (10.42–663.68), 236.89 (18.83–418.99) and 237.31 (2.26–3101.00) (p =.736); the median values with 95% CI of serum sFlt-1 levels in placenta previa, FIGO grade I, grade II, and grade III were 2816.50 (418.00–12925.00), 2506.00 (227.50-16104.00), 2494.50 (888.52–20812.00), and 1601.00 (662.16–9574.00) (p =.037). Placental PLGF expression in placenta previa, FIGO grade 1, grade II, and grade III showed median values (with 95% CI) of 4.00 (1.00-9.00), 4.00 (2.00–9.00), 4.00 (4.00–9.00), and 6.00 (2.00–9.00) (p =.001); sFlt-1 expression median values (with 95% CI) were 6.00 (2.00–9.00), 6.00 (2.00–9.00), 4.00 (1.00–9.00), and 4.00 (1.00–9.00) (p =.004). Serum PLGF and sFlt-1 levels did not correlate with placental tissue expression (p =.228; p =.586). Conclusion: There are differences in PAS's angiogenic processes ​according to the severity of trophoblast cell invasion. But there is no overall correlation between serum levels and PLGF and sFlt-1 expression in the placenta, suggesting the imbalance between angiogenic and anti-angiogenic are local mechanisms in the placental and the uterine wall.