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Section 2 of 6 · Open sections

Required section · Section 2 of 6

Two layers of evidence

The clinical definition begins with new-onset hypertension after 20 weeks. ACOG criteria allow proteinuria to establish the condition, or, when proteinuria is absent, new thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or specified neurologic symptoms. Gestational hypertension has hypertension without proteinuria or severe features. Chronic hypertension and superimposed preeclampsia require the clinical timeline as well as laboratory context.

Placental angiogenic balance is a second layer of evidence. Soluble fms-like tyrosine kinase-1, abbreviated sFlt-1, is antiangiogenic and binds vascular endothelial growth factor and placental growth factor, abbreviated PlGF. PlGF is proangiogenic. Higher circulating sFlt-1 and lower PlGF can precede clinical preeclampsia, but the ratio summarizes a pathway signal rather than proving a diagnosis.

Both analytes shift with gestational age even in uncomplicated pregnancy. That physiologic change is one reason a ratio claim must name its gestational window and intended population. Keep the clinical criteria, routine laboratory evidence, and biomarker risk claim in separate mental compartments before integrating them.

Illustrative drawing — this picture was drawn rather than captured.

Two-layer diagram shows increased placental sFlt-1 and reduced available PlGF contributing to a maternal vascular signal; the ratio measures balance and is not a diagnosis.
Figure 1Placental angiogenic imbalance supplies pathway context for the sFlt-1/PlGF ratio.

Use this sequence to keep a ratio result attached to its validated claim.

  1. Confirm clinical context

    Establish gestational age, hypertension status, pregnancy type, and the reason for evaluation.

  2. Review routine domains

    Assess proteinuria, platelets, creatinine, transaminases, and hemolysis evidence with specimen quality.

  3. Verify assay boundary

    Confirm the assay, specimen pairing, analyzer, intended-use population, gestational window, and current local method information.

  4. Communicate bounded result

    Release results and communicate urgent findings by local policy while stating what the ratio supports and what it cannot establish.

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Knowledge check 1

Which statements describe the angiogenic model taught here?

Choose at least 2 options.

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