Clinical implementation of the sFlt-1/PlGF ratio to identify preeclampsia and fetal growth restriction: A prospective cohort study

•sFlt-1/PlGF at 24–28 weeks in high-risk women predicts most early PE/FGR cases.•Optimal diagnostic accuracy was obtained for sFlt-1/PlGF values >95th centile.•High-risk women with sFlt-1/PlGF ≤95th centile at 24–28 weeks can be reassured. To analyze the usefulness of a clinical protocol for early detection of preeclampsia and/or fetal growth restriction (PE/FGR) using, in previously selected pregnancies, the measurement of the sFlt-1/PlGF ratio at 24–28 weeks of gestation. Prospective observational cohort study carried out in a single tertiary hospital in Spain. 5601 consecutive singleton pregnancies with complete follow-up were included. High-risk women for PE/FGR were selected by combining data from maternal history and second trimester uterine artery Doppler. Subsequently these patients underwent intensive monitoring, including the measurement of the sFlt-1/PlGF ratio at 24–28 weeks to predict PE/FGR. Early, intermediate and late PE/FGR (delivery