Published: 2020-02-27

Comparative study of sFlt-1/Plgf ratio with uterine artery doppler indices in prediction of preeclampsia at 22-24 weeks period of gestation

Taru Gupta, Pooja Sharma, Sarika Arora, Divya Baruhee


Background: Hypertensive disorders like pre-eclampsia along with hemorrhage and infection, contributes greatly to maternal morbidity and mortality. Various pro and antiangiogenic factors like sFlt-1 and Plgf have been linked to the etiopathogenesis of placental vascular disease and their combination with uterine artery doppler studies may improve the prediction accuracy. Present study was conducted to analyze sFlt-1/Plgf ratio and uterine artery doppler indices among high risk patients and to compare these in prediction of preeclampsia.

Methods: A prospective observational study was conducted from September 2017 to February 2019 in which 100 patients giving consent and satisfying inclusion criteria were evaluated for various risk factors and were subjected to sFlt-1/Plgf ratio test and uterine artery doppler study at 22-24 weeks period of gestation. They were followed up and maternal outcome was analysed.

Results: Among the cohort of 100 women with high risk factors, 35% of the study participants developed pre-eclampsia. Using sFlt-1/Plgf ratio 40% of them were screened positive for pre-eclampsia. This percentage of screened positive was 40%, 43%, and 53% using uterine artery RI, PI, and SD respectively. sFlt-1/Plgf was found to have a sensitivity of 91.4% and specificity of 87.7%. ROC curve analysis showed highest area under curve (AUC) for sFlt-1/Plgf (0.858).

Conclusions: sFlt-1/Plgf ratio was found to be a better predictable biomarker than uterine artery Doppler indices in prediction of pre-eclampsia at 22-24 weeks period of gestation.


High risk, Pre-eclampsia, Resistive index, Systolic to diastolic, sFlt-1/Plgf, Uterine artery

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Kenneth J Leveno (ed.). Williams Manual of Pregnancy Complications. Hypertensive disorders. 23rd Edition. New York: McGraw Hill Professional; 2013:728.

Staff AC, Johnsen GM, Dechend R, Redman CW. Preeclampsia and uteroplacental acute atherosis: immune and inflammatory factors. J Reprod Immunol. 2014;101-102:120-6.

Brownfoot FC, Hastie R, Hannan NJ, Cannon P, Tuohey L, Parry LJ, et al. Metformin as a prevention and treatment for preeclampsia: effects on soluble fms-like tyrosine kinase 1 and soluble edoglin secretion and endothelial function. Am J Obstet Gynecol. 2016;214(3):356.e1-356.e15.

Lecarpentier E, Vieillefosse S, Haddad B, Fournier T, Leguy MC, Guibourdenche J, et al. Placental growth factor (PIGF) and s-Flt-1 during pregnancy: physiology, assay and interest in preeclampsia. Ann Biol Clin (Paris). 2016;74(3):259-67.

Herraiz I, Llurba E, Verlohren S, Galindo A. Update on the diagnosis and prognosis of preeclampsia with the aid of the sFlt-1/ PlGF ratio in singleton pregnancies. Fetal Diagn Ther. 2018;43:81-9.

Park HJ, Kim SH, Jung YW, Shim SS, Kim JY, Cho YK, et al. Screening models using multiple markers for early detection of late-onset preeclampsia in low-risk pregnancy. BMC Preg Childbirth. 2014;14(1):35.

Van Helden J, Weiskerchen R. Analytical evolution of the novel soluble fms-like tyrosine kinase-1 and placental growth factor assays for diagnosis of preeclampsia. Clin Biochem. 2015;48(16-17):1113-9.

Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. New Eng J Med. 2016;374(1):13-22.

Velauthar L, Plana MN, Kalidindi M, Zamora J, Thilaganathan B, Illanes SE, et al. First‐trimester uterine artery Doppler and adverse pregnancy outcome: a meta‐analysis involving 55 974 women. Ultrasound Obstet Gynecol, 2014;43:500-7.

Vellamkondu A, Vasudeva A, Bhat RG, Kamath A, Amin SV, Rai L, et al. Risk assessment at 11-14-week antenatal visit: a tertiary referral center experience from south India. J Obstet Gynaecol India. 2017;67(6):421-7.

Li L, Zheng Y, Zhu Y, Li J. Serum biomarkers combined with uterine artery Doppler in prediction of preeclampsia. Exp Ther Med. 2016;12(4):2515-20.

Perales A, Delgado JL, de la Calle M, García‐Hernández JA, Escudero AI, Campillos JM, et al. sFlt-1/PLGF for prediction of early-onset pre-eclampsia: STEPS (Study of Early Pre-eclampsia in Spain). Ultrasound Obstet Gynecol. 2017;50(3):373-82.

Elbishry GM, Serag Eldin IF, ElShahawy AA, Hawwary GE, Riad AM. Role of soluble FMS-like tyrosine kinase (SFLT-1) /placental growth factor (Plgf) ratio as prognostic marker for cases of preeclampsia. J Gynecol Res Obstet. 2017;3(2):037-45.

Tarasevičienė V, Grybauskienė R, Mačiulevičienė R. sFlt-1, PlGF, sFlt-1/PlGF ratio and uterine artery Doppler for preeclampsia diagnostics. Medicina. 2016:52(6):349-53.

Gomez-Arriaga PI, Herraiz I, Lopez-Jimenez EA, Escribano D, Denk B, Galindo A. Uterine artery Doppler and sFlt-1/PlGF ratio: prognostic value in early-onset pre-eclampsia. Ultrasound Obstet Gynecol. 2014;43:525-32.

Narang S, Agarwal A, Das V, Pandey A, Agrawal S, Ali W. Prediction of preeclampsia at 11-14 weeks of pregnancy using mean arterial pressure, uterine artery Doppler and pregnancy associated plasma protein-A. Int J Reprod Contracept Obstet Gynecol. 2016;5(11):3948-53.

Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, et al. Predictive value of the sFlt-1:PlGF ratio in women with suspected preeclampsia. New Eng J Med. 2016;374(1):13-22.