Abstract

ABSTRACT Pre-eclampsia (PE) is a globally prevalent complication of pregnancy whose prevalence in India is near the higher value of the global average. The diagnosis and prediction of PE is currently based on nonspecific clinical signs such as hypertension and proteinuria. PE is associated with significant morbidity and mortality for the mother as well as the fetus. Placental growth factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1) are key factors in the pathophysiology of PE. In PE patients, sFlt-1 levels increase and PlGF levels fall, resulting in an elevation of the sFlt-1/PlGF ratio. A recent NICE recommendation has included sFlt-1 PlGF ratio for the diagnosis of early PE. The sFlt-1/PlGF ratio appears to be an important triage tool in patients at risk of placenta-related disorders, in the second half of pregnancy, and also helps stratify those likely to develop adverse fetal outcomes from the others. The diagnostic strategy for PE is based on a dual cut-off. The suggested cut-offs between 20+0 and 33+6 weeks are ≤33 and ≥85 for rule-out and rule-in of PE respectively, and the values for 34+0 weeks and beyond are ≤33 and ≥110 respectively. A preliminary analysis of a study being conducted in India showed that the usage of sFlt-1/PlGF ratio resulted in continuation of stable pregnancies beyond 37 weeks without increase in perinatal mortality. Implementation of sFlt-1/PlGF ratio in the diagnostic process may help in optimizing care by improving management of women with suspected PE.