Background: The sFlt-1/PlGF ratio is an established angiogenic biomarker assay used to support the diagnosis and risk stratification of preeclampsia. This study evaluated its implementation over a one-year period, with a focus on its utility in supporting clinical decision-making in rural populations.
Methods: A retrospective audit was conducted of all sFlt-1/PlGF tests performed between November 2022 and December 2023. Clinical indications, maternal demographics, and pregnancy outcomes were extracted from electronic records and analysed using REDCap. Results were categorised as normal (≤38), moderately high (>38–85), and very high (>85) to guide clinical management.
Results: Among 283 individuals tested, 17.3% (n=49) resided in rural areas. Within this rural cohort, self-reported ethnicity was Māori (3, 6.1%), Pacific People (2, 4.1%), South Asian (8, 16.3%), Southeast Asian (6, 12.2%), European (29, 59.2%), Other (1, 2.0%). Primary indications for testing were suspected preeclampsia (73.5%) and fetal growth restriction (26.5%), with a median gestational age at testing of 31.6 (IQR 28.3-34.3) weeks. The sFlt-1/PlGF result influenced follow-up intensity in 65.3% of rural cases: surveillance was decreased in 18 (including 10 inpatient discharges) and increased in 14 (including 9 hospital admissions). Median gestation at birth decreased with rising test category: 38.0 (37.3-38.9), weeks (normal), 37.0 (34.6-37.3) weeks (moderately high), and 32.3 (29.6-35.6) weeks (very high).
Conclusion: Use of the sFlt-1/PlGF ratio meaningfully informed pregnancy management in rural populations, improving risk stratification in suspected preeclampsia. Wider access to this test may reduce unnecessary hospital transfers and support timely referral for high-risk pregnancies in geographically remote settings.