A woman with severe pre-eclampsia at 28 weeks is being managed expectantly. The sFlt-1/PlGF ratio on serum testing is 85. Which statement about this biomarker is correct?
- A PlGF elevation reflects placental ischemia and directly causes hypertension
- B sFlt-1 is a pro-angiogenic factor that promotes trophoblast invasion
- C sFlt-1/PlGF ratio >38 is associated with high risk of developing pre-eclampsia within 4 weeks ✓
- D A normal ratio excludes pre-eclampsia with severe features
Correct answer: C. sFlt-1/PlGF ratio >38 is associated with high risk of developing pre-eclampsia within 4 weeks
Explanation
Soluble fms-like tyrosine kinase-1 (sFlt-1) is an anti-angiogenic factor that sequesters VEGF and PlGF, impairing endothelial function. PlGF (placental growth factor) is a pro-angiogenic factor that is decreased in pre-eclampsia due to sFlt-1 excess. An sFlt-1/PlGF ratio >38 before 34 weeks has high sensitivity and NPV for predicting pre-eclampsia onset within 4 weeks. sFlt-1 is anti-angiogenic (not pro-angiogenic), and PlGF is decreased, not elevated, in pre-eclampsia.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.