Predictive Value of Soluble fms-Like Tyrosine Kinase-1 to Placental Growth Factor Ratio for Adverse Maternal-Fetal Outcomes in Late-Onset Preeclampsia

International Journal of Obstetrics and Gynecology | Vol. 14, No. 8, August 2026 | pp. 217–228

DOI: 10.46882/2026/IJOG/000495

Original Research Article

Title: Predictive Value of Soluble fms-Like Tyrosine Kinase-1 to Placental Growth Factor Ratio for Adverse Maternal-Fetal Outcomes in Late-Onset Preeclampsia

Names of Authors: Oluwaseun A. Adebayo¹, Chinedu O. Okafor², Aminat Z. Yusuf¹

Authors’ Affiliations:
¹ Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
² Department of Maternal-Fetal Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria

Abstract:
Late-onset preeclampsia (occurring at or after 34 weeks of gestation) presents highly unpredictable clinical courses, requiring robust biomarkers to optimize delivery timelines. This prospective observational study evaluated the diagnostic accuracy of the serum soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio in predicting severe maternal and fetal complications within 14 days of clinical presentation. A cohort of 240 singleton pregnancies diagnosed with mild late-onset preeclampsia between 34 and 36⁺⁶ weeks was monitored. Serum concentrations of sFlt-1 and PlGF were measured at the time of initial diagnosis, and patients were followed until delivery. The primary composite endpoint included severe maternal complications (HELLP syndrome, eclampsia, placental abruption, or acute renal failure) or adverse neonatal outcomes (stillbirth, severe growth restriction, or neonatal intensive care admission) within two weeks. Sixty-two women (25.8%) experienced the composite endpoint. The median sFlt-1/PlGF ratio was significantly higher in women with adverse outcomes compared to those with stable courses (124.5 vs. 34.2, p < 0.001). An sFlt-1/PlGF ratio threshold ≥ 85 demonstrated a sensitivity of 87.1%, a specificity of 83.1%, a positive predictive value of 64.3%, and a negative predictive value of 94.7% for forecasting complications within 14 days. Receiver operating characteristic analysis yielded an Area Under the Curve [AUC] of 0.89. The sFlt-1/PlGF ratio serves as an effective diagnostic tool in late-onset preeclampsia to identify patients at imminent risk of severe complications, guiding inpatient management and safe delivery choices.

Keywords: Late-Onset Preeclampsia; sFlt-1/PlGF Ratio; Angiogenic Biomarkers; Maternal Complications; Placental Growth Factor; Perinatal Surveillance.

Manuscript Timeline: Received: May 10, 2026; Revised: July 01, 2026; Accepted: July 22, 2026; Published: August 11, 2026.

Citation: Adebayo OA, Okafor CO, Yusuf AZ. Predictive Value of Soluble fms-Like Tyrosine Kinase-1 to Placental Growth Factor Ratio for Adverse Maternal-Fetal Outcomes in Late-Onset Preeclampsia. International Journal of Obstetrics and Gynecology. 2026; 14(8): 217–228.

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