Angiogenic markers in pre-eclampsia show which characteristic pattern in the weeks preceding clinical onset?

• A Decreased PlGF and markedly elevated sFlt-1, leading to an elevated sFlt-1/PlGF ratio ✓
• B Elevated PlGF (placental growth factor) and elevated sFlt-1 (soluble FMS-like tyrosine kinase)
• C Decreased VEGF with no change in PlGF or sFlt-1
• D Elevated sEng (soluble endoglin) alone without changes in sFlt-1

Explanation

In pre-eclampsia, there is an imbalance between anti-angiogenic and pro-angiogenic factors: sFlt-1 (a soluble decoy receptor for VEGF and PlGF) is elevated, binding and neutralizing free PlGF, which results in markedly decreased free PlGF and an elevated sFlt-1/PlGF ratio. This ratio rises 4–8 weeks before clinical onset. An sFlt-1/PlGF ratio >38 has high sensitivity and specificity for ruling-in pre-eclampsia within 4 weeks (PROGNOSIS trial). This forms the basis of angiogenic marker testing in suspected PE.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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