According to the sFlt-1/PlGF ratio for prediction of pre-eclampsia, a ratio of ≤38 at 24–37 weeks is used to rule out pre-eclampsia in the short term. In a woman with a sFlt-1/PlGF ratio of 85 at 32 weeks with mild hypertension, what is the most appropriate management decision supported by current ACOG/ISSHP 2022 guidelines?
- A Enhanced surveillance with admission, fetal monitoring, and plan for delivery if ratio exceeds 85 ✓
- B Expectant management until 37 weeks regardless of symptoms
- C Immediate delivery by caesarean section
- D Increased antihypertensive therapy alone and repeat ratio in 4 weeks
Explanation
An sFlt-1/PlGF ratio of 85 at 32 weeks places the patient in the 'increased risk' zone (ratio 38–85 indicates moderate risk; >85 indicates imminent pre-eclampsia within 4 weeks). Current guidelines recommend enhanced surveillance including hospital admission, twice-weekly assessment of maternal and fetal parameters, and planning for delivery if clinical pre-eclampsia develops or the gestational age permits safe delivery. Immediate caesarean is not indicated without severe features; expectant management without enhanced monitoring risks maternal deterioration; adjusting antihypertensives alone does not address the underlying pathology.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.