Han Zhang,1 Cui Xu2 

1Gynecology Department, the Second Affiliated Hospital of Shandong First Medical University, Tai ‘an, Shandong, 271000, People’s Republic of China; 2Obstetrics Department, the Second Affiliated Hospital of Shandong First Medical University, Tai ‘an, Shandong, 271000, People’s Republic of China

Correspondence: Cui Xu, Email sdta2025@163.com

Objective: This study aimed to evaluate the predictive efficacy of combining serum soluble fms-like tyrosine kinase-1/placental growth factor (sFlt-1/PlGF) ratio with uterine artery Doppler ultrasound for early-onset preeclampsia (PE) before 34 weeks’ gestation.
Methods: A retrospective cohort analysis was conducted on 148 singleton pregnancies (control group: n = 76; early-onset PE group: n = 72) who delivered at our institution between July 2023 and June 2024. At 24– 28 weeks, serum sFlt-1 and PlGF levels were quantified via electrochemiluminescence immunoassay (Roche Elecsys®), and uterine artery pulsatility index (PI), resistance index (RI), and systolic/diastolic ratio (S/D) were measured by Doppler ultrasound (M22 system, standardized settings). Logistic regression and receiver operating characteristic (ROC) curves assessed predictive performance.
Results: Compared to controls, PE patients exhibited significantly elevated sFlt-1 (24.02 ± 6.68 vs 16.38 ± 7.47 μg/L; P < 0.001), reduced PlGF (1.22 ± 0.14 vs 1.54 ± 0.30 μg/L; P < 0.001), and higher sFlt-1/PlGF ratio (20.76 ± 7.71 vs 10.11 ± 4.10; P < 0.001). Doppler indices were markedly increased in PE: PI (1.34 ± 0.26 vs 0.82 ± 0.11; P < 0.001), RI (0.78 ± 0.12 vs 0.51 ± 0.07; P < 0.001), and S/D (3.89 ± 0.97 vs 2.11 ± 0.41; P < 0.001). Multivariate analysis confirmed all parameters as independent predictors (P < 0.05), with sFlt-1/PlGF ratio having the highest odds ratio (OR = 1.332, 95% CI: 1.128– 1.573). The combined model achieved superior predictive performance: area under curve (AUC)=0.954 (95% CI: 0.92– 0.99) vs sFlt-1/PlGF alone (AUC = 0.887; P = 0.003) or PI alone (AUC = 0.821; P < 0.001), with sensitivity 82.2%, specificity 96.7%, and accuracy 94.7%.
Conclusion: Integration of sFlt-1/PlGF ratio and uterine artery Doppler parameters (particularly uterine artery PI and RI) significantly enhances early-onset PE prediction, providing a robust tool for clinical risk stratification.

Keywords: Serum sFlt-1/PlGF ratio, uterine artery blood flow ultrasound, early-onset preeclampsia, prediction