Poster Session 3
Category: Hypertension
Poster Session 3
Sonya Fabricant, MD (she/her/hers)
Maternal-Fetal Medicine Fellow
Cedars-Sinai Medical Center
Los Angeles, California, United States
Candace Levian, MD
Maternal-Fetal Medicine Physician
Cedars-Sinai Medical Center
Los Angeles, California, United States
Tania Esakoff, MD
Maternal-Fetal Medicine Physician
Cedars-Sinai Medical Center
Los Angeles, California, United States
To evaluate the relationship between degree of sFlt-1:PlGF ratio (SFLT) elevation and need for delivery within 48 hours (48h).
Study Design:
This was a retrospective cohort study of individuals who delivered at a quaternary care center between 10/13/2023 and 6/21/25. Eligible individuals presented with elevated blood pressure (BP) and had an SFLT performed ≤ 33w4d gestation. SFLT was used to augment clinical evaluation but not to guide delivery timing. Subjects were identified using the Deep6 natural language search engine. Data were abstracted from the medical record. The relationship between time from SFLT collection to delivery was assessed via linear regression (time from SFLT to delivery as a continuous variable) and logistic regression (time from SFLT to delivery < 48h), adjusting for covariates. The diagnostic accuracy of SFLT for delivery < 48h was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Diagnostic test statistics for SFLT thresholds were calculated.
Results:
Of 68 eligible individuals, 12 (18%) delivered within 48h. On linear regression modeling, higher SFLT was independently associated with shorter time to delivery (β = –4.1 days per 100 point increase in the ratio, 95% CI -6.0 – -2.0, p < 0.01). The relationship between SFLT level and time to delivery is illustrated in the Figure. After adjusting for covariates (age, race, BMI, insurance), each 100 point increase in SFLT was associated with a 1.97-fold increase in odds of delivery < 48h (95% CI 1.28-3.03, p < 0.01) (Table). The adjusted AUC for delivery < 48h was 0.85 (95% CI 0.73-0.98). An SFLT threshold ≥ 320 optimized Youden’s index (0.56), yielding a 67% sensitivity, 89% specificity, 93% NPV and 57% PPV for delivery < 48h. A threshold ≥ 694 had a 33% sensitivity, 100% specificity, 87% NPV and 100% PPV for delivery < 48h.
Conclusion:
Among individuals ≤ 33w4d presenting with elevated BP, greater degree of SFLT elevation is associated with increased odds of delivery within 48h. These findings can guide counseling for patients with elevated BP who have an SFLT performed in pregnancy.