sFlt-1/PlGF Ratio, Serum

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Angiogenic factor ratio.

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sFlt-1/PlGF Ratio Serum - Comprehensive Medical Test Guide

Section 1: Why is it done?
- Test Purpose: The sFlt-1/PlGF ratio measures the balance between soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) in serum. This ratio is a biomarker used to assess the risk and progression of preeclampsia and related placental disorders during pregnancy.
- Primary Indications for Testing: Evaluation of suspected preeclampsia in pregnant women Assessment of atypical presentations of hypertensive disorders in pregnancy Differentiation between preeclampsia and other causes of hypertension during pregnancy Monitoring pregnant women with risk factors for preeclampsia Evaluation of severe headache, visual disturbances, or epigastric pain in pregnancy Assessment of fetal growth restriction and placental insufficiency
- Timing of Testing: Typically performed during the second and third trimester (after 20 weeks gestation) Most commonly used between 24-34 weeks of gestation Can be repeated at intervals to monitor disease progression Useful in acute clinical decision-making when preeclampsia is suspected
Section 2: Normal Range
- Reference Range Values: Normal ratio: <38 (varies slightly by laboratory and trimester) Borderline range: 38-85 Elevated/Abnormal: >85
- Units of Measurement: Ratio (unitless value derived from ng/mL of sFlt-1 divided by pg/mL of PlGF) sFlt-1 measured in ng/mL (nanograms per milliliter) PlGF measured in pg/mL (picograms per milliliter)
- Result Interpretation: Normal (<38): Low risk of preeclampsia in the next 4 weeks; helps exclude preeclampsia Borderline (38-85): Intermediate risk; close clinical monitoring recommended Elevated (>85): High risk for preeclampsia; warrants clinical intervention and further evaluation Negative result: Preeclampsia is less likely; normal pregnancy more probable Positive result: Elevated risk; consistent with preeclampsia; requires clinical correlation
- Clinical Significance: Normal results have high negative predictive value, reliably ruling out preeclampsia Abnormal results have high positive predictive value for preeclampsia diagnosis Results are most reliable between 24-34 weeks gestation Can help prevent unnecessary interventions when results are normal
Section 3: Interpretation
- Detailed Result Interpretation: Ratio <38: Strong evidence against preeclampsia; low probability of disease development within 4 weeks; supports expectant management in suspected cases Ratio 38-85: Intermediate zone; requires clinical judgment; additional monitoring and repeat testing may be warranted Ratio >85: Highly suggestive of preeclampsia; consistent with endothelial dysfunction characteristic of the disease
- Clinical Pathophysiology: In preeclampsia, sFlt-1 levels increase excessively while PlGF levels decrease sFlt-1 antagonizes pro-angiogenic factors, leading to endothelial dysfunction This imbalance disrupts vascular homeostasis and causes hypertension The elevated ratio reflects the degree of placental dysfunction
- Factors Affecting Results: Gestational age at time of testing Multiple gestations (may have higher baseline ratios) Presence of diabetes or hypertension Renal disease or antiphospholipid syndrome Timing of specimen collection relative to symptom onset Laboratory-specific assay methodology Previous history of preeclampsia
- Serial Measurement Interpretation: Rising ratio over time increases risk of progression to severe preeclampsia Rapidly increasing ratios may indicate acute disease progression Persistent elevation suggests ongoing placental dysfunction Stable or decreasing ratios may indicate stabilization or resolution Delta changes (rate of change) provide additional prognostic information
- Clinical Decision Points: Ratio >38 in first/early second trimester may indicate very high risk Ratio >85 at any gestational age is concerning and warrants clinical action Combined with clinical symptoms, very high sensitivity and specificity Normal ratio in symptomatic patient may reduce need for immediate delivery Test helps guide intensity and timing of clinical follow-up
Section 4: Associated Organs
- Primary Organ Systems Involved: Placenta: Primary site of pathology; dysfunction drives the disease Vascular system: Endothelial dysfunction affects multiple organs Brain: Risk of eclampsia, stroke, reversible posterior leukoencephalopathy syndrome Kidneys: Glomerular endotheliosis, proteinuria, acute kidney injury Heart: Increased cardiac output demand, myocardial infarction risk Liver: Hepatic capsule distension, HELLP syndrome
- Medical Conditions Associated with Abnormal Results: Preeclampsia (without severe features): Elevated ratio without severe symptoms Severe preeclampsia: Markedly elevated ratio with clinical deterioration Preeclampsia with severe features: Progressive organ involvement HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets Fetal growth restriction: Often coexists with placental insufficiency Intrauterine fetal demise: Associated with severe placental dysfunction Superimposed preeclampsia: In women with chronic hypertension
- Diseases This Test Helps Diagnose or Monitor: Preeclampsia: Primary indication for the test Gestational hypertension: Differentiation from preeclampsia Placental insufficiency syndromes Early-onset preeclampsia: Particularly valuable before 34 weeks Recurrent preeclampsia: Monitoring in subsequent pregnancies
- Potential Complications from Abnormal Results: Maternal eclampsia: Seizures from severe hypertension and cerebral edema Cerebral hemorrhage: Risk of maternal stroke Pulmonary edema: From fluid overload and cardiovascular strain Acute kidney injury: Progressing renal dysfunction Hepatic rupture: From HELLP syndrome Placental abruption: Risk of catastrophic hemorrhage Disseminated intravascular coagulation: Severe thrombotic complications Maternal death: In untreated severe preeclampsia Fetal complications: Intrauterine growth restriction, prematurity, demise
Section 5: Follow-up Tests
- Recommended Follow-up Tests Based on Results: Complete metabolic panel: Assess kidney and liver function Platelet count: Screen for thrombocytopenia Coagulation studies (PT/INR, PTT): Evaluate for DIC LDH level: Indicator of hemolysis Bilirubin (total and direct): Assess for hemolysis Spot protein-to-creatinine ratio or 24-hour urine protein: Quantify proteinuria Blood pressure monitoring: Serial measurements to assess hypertension severity
- Further Investigations as Needed: Obstetric ultrasound: Assess fetal growth, amniotic fluid volume, Doppler studies Cardiotocography/fetal heart rate monitoring: Evaluate fetal well-being Serum creatinine: Baseline renal function assessment Peripheral blood smear: Evaluate for schistocytes in HELLP syndrome CT or MRI of brain: If eclampsia or neurologic symptoms present Ophthalmology examination: If visual symptoms reported
- Monitoring Frequency: Normal ratio: Routine obstetric follow-up (typically every 4 weeks after delivery) Borderline ratio: Repeat testing in 1-2 weeks if clinically indicated Elevated ratio: More intensive monitoring; repeat testing as clinically indicated Severe preeclampsia: Daily or more frequent monitoring Post-delivery: Follow-up testing may be repeated if initial diagnosis unclear Long-term follow-up: Blood pressure monitoring in postpartum period (up to 12 weeks)
- Related Complementary Tests: Individual sFlt-1 and PlGF measurements: Component values may provide additional information Endoglin (sEng) level: Emerging biomarker; sFlt-1/PlGF combined with sEng may improve prediction Pregnancy-associated plasma protein A (PAPP-A): First trimester screening Placental growth factor (PlGF) alone: May be measured as alternative screening Soluble endoglin (sEng): Particularly elevated in severe preeclampsia and HELLP Angiogenic factors profile: Comprehensive assessment when available
Section 6: Fasting Required?
- Fasting Requirement: NO - Fasting is NOT required for the sFlt-1/PlGF ratio serum test
- Specimen Collection Instructions: Test can be performed at any time of day No dietary restrictions necessary Patient may eat and drink normally before collection Specimen is collected via venipuncture into a serum separator tube (SST) Approximately 3-5 mL of blood is required
- Medications to Continue: All routine medications should be continued as normal No medications need to be held prior to testing Prenatal vitamins should be taken as prescribed Blood pressure medications should be taken as directed by physician Antihypertensive agents do not interfere with test results
- Other Patient Preparation Requirements: Patient should be seated or lying down for 15 minutes prior to collection to reduce stress Accurate gestational age documentation is important for result interpretation Inform phlebotomist of current symptoms (headache, visual changes, epigastric pain) Timing of collection should be documented Recent fluid intake or output should be noted if relevant No special handling required; specimen should be transported promptly to laboratory Results are typically available within 24 hours

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