A woman at 28 weeks gestation has BP 152/100 mmHg on two readings 6 hours apart with 24-hour urinary protein 350 mg. Her sFlt-1:PlGF ratio is 110. Under the FIGO 2018 first-trimester screening algorithm, which combination of biomarkers most accurately identifies women at high risk for early-onset pre-eclampsia (before 34 weeks)?

• A Uterine artery PI + MAP + PAPP-A + PlGF at 11–14 weeks ✓
• B Serum AFP + HCG + uterine artery PI at 16–20 weeks
• C Serum uric acid + blood pressure + urine protein at 20 weeks
• D Uterine artery notching alone at 22–24 weeks combined transvaginal

Explanation

The FIGO 2018 combined first-trimester screening algorithm at 11–13+6 weeks integrates mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), serum PAPP-A, and PlGF to achieve a detection rate of ~75% for early-onset pre-eclampsia with a 10% false-positive rate. This performance is far superior to any second-trimester or single-marker approach. Low-dose aspirin (150 mg/day) initiated before 16 weeks in high-risk women (ASPRE trial) reduces early-onset pre-eclampsia by ~62%.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.