Consensus statement on the potential implementation of the sFlt-1/PlGF ratio in women with suspected pre-eclampsia

Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity worldwide, and places a significant burden on the South African (SA) healthcare system. The soluble fms-like tyrosince kinase (sFlt-1)/placental growth factor (PlGF) ratio can serve as a diagnostic aid for PE, and should be used in combination with clinical judgement and other ancillary tests. The Preeclampsia Advisory Board was convened on 31 March 2017, with experts in the field of PE from various hospitals and universities around the country in attendance. An international expert gave insight into best practices from countries that have implemented the Elecsys immunoassay sFlt-1/PlGF ratio. Others recommend that the sFlt-1/PlGF ratio be implemented in clinical practice when clinical diagnosis is in doubt in patients with suspected PE, in the interests of avoiding unnecessary hospitalisation and interventions. The strength of the test lies in its negative predictive value in ruling out PE. Ruling out PE could drive cost savings, as fewer women would be needlessly admitted to hospital, and there could, in addition, be fewer iatrogenic preterm deliveries, which are associated with considerable morbidity and cost. As most data are derived from high-income countries, multicentre studies are required to assess the clinical performance of this test within the context of SA.