The prognostic value of extremely high sFlt-1/PLGF in the progression of early onset severe preeclampsia

Background. To describe a case of severe preeclampsia where the finding of an extremely high sFlt-1/PLGF ratio correlated with fast disease progression.
Case presentation. We reviewed the case of a 36-year-old nul­liparous patient with a spontaneous pregnancy and no pre­eclampsia screening during first trimester CST. She accessed our triage at 28 gw for diarrhoea; a casual diagnosis of oligo­hydramnios was performed (negative PAMG-1).
Results. A scan revealed stage 1 IUGR (EFW 650 g), increased uterine artery Doppler and normal foetal Doppler. The pla­centa appeared uneven with hypoechoic areas. Following an increase in her blood pressure, she was started on nifedipine 20 mg TID and underwent steroids for lung maturity. sFlt-1/ PLGF ratio was 1,295, and 24-hour urinary protein was 1.523 g. Two days after admission, she developed oliguria and com­plained of breathing difficulties. A transthoracic echo revealed normal intravascular volume with a bilateral pleural effusion; this deteriorated in the following days along with a further in­crease in anti-hypertensive medication. EMCS was performed one week after admission for derangement of maternal con­ditions. A female baby (690 g) was successfully delivered, APGAR 7-9, arterial pH 7.24 with BE -6. Anti-hypertensive treatment was gradually decreased after EMCS, discharge oc­curred after 7 days. Pathology revealed a 4cm retroplacental haematoma and maternal-vascular-malperfusion (MVM).
Conclusions. This is an emblematic case of the correlation be­tween an extremely high sFlt1/PLGF ratio, preeclampsia with an exponential clinical derangement and severe placental al­terations. sFlt-1/PLGF is validated as a negative predictive tool, yet prospective studies on the prognostic role of sFlt-1/ PLGF would be extremely useful to correctly manage patients with early onset preeclampsia.

Table of Content: Vol. 36 (Supplement No. 1) 2024 – Conference Proceedings

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