Around 6 % of women received at least one test during their pregnancy; the prevalence of preterm pre-eclampsia was 1.35 %.

sFLT:PlGF showed very high diagnostic accuracy compared to a clinical diagnosis of pre-eclampsia.

False negative results were more common in twin pregnancies where there was discordant fetal growth.

PlGF was associated with indicators of placental insufficiency including fetal growth whilsts FLT was associated with indicators of maternal disease and time to birth.

Whilst increasing levels of the sFLT:PlGF ratio were associated with the development of severe pre-eclampsia, no threshold was identified which would justify immediate preparation for birth.

To evaluate real-world implementation of angiogenic biomarkers (sFLT1:PlGF, Roche Elecsys®) to enhance the diagnosis of pre-eclampsia within a UK tertiary maternity centre.

Retrospective cohort study.

Perinatal outcomes were collated from routine pregnancy data and compared before and after the introduction of sFLT1:PlGF ratio testing. For those women receiving a test (September 2019 to Feb 2021), the diagnosis of pre-eclampsia and adverse events were recorded.

From routinely recorded data, there was a trend towards a rise in the proportion of births 34–37 weeks (4.8 % vs 5.4 %; p = 0.054) after test implementation, crude perinatal mortality rates were not different. Detailed outcomes were available for 660 pregnancies following sFLT1/PlGF testing of whom 30.7 % developed pre-eclampsia, 153 (23.2 %) required birth before 37 weeks. 99 % of the pregnancies complicated by a sFLT:PlGF ratio ≥ 85 had a clinical diagnosis of pre-eclampsia, 6/13 false negative tests (ratio < 38) were in twin pregnancies. Higher sFLT:PlGF ratios or lower PlGF values correlated with preterm birth and lower birth weight percentiles, while higher sFLT levels were associated with a reduced test to birth interval.

Introduction of sFLT:PlGF ratio testing for suspected pre-eclampsia demonstrated very high diagnostic accuracy but was not associated with a measurable difference in perinatal outcomes within the maternity population. sFLT:PlGF testing identified a sub-group of women with ratio values ≥ 85 that were more likely to require high-dependency care, however absolute levels of either sFLT-1 or PlGF were not strongly associated with clinical features of maternal or perinatal disease severity.

Pre-eclampsia

Soluble Fms-like tyrosine kinase-1 (sFLT)

Placental Growth Factor

Implementation

Perinatal mortality

© 2025 The Authors. Published by Elsevier B.V. on behalf of International Society for the Study of Hypertension in Pregnancy.