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To evaluate whether a single determination of the serum sFlt-1/PlGF ratio associates with pregnancy prolongation and adverse outcome in women with suspected or confirmed preeclampsia (PE) and whether this ratio has additive value in addition to the current standard diagnosis of PE.In this ongoing observational Dutch multicenter study (600 pts to be enrolled) blood was drawn at admission. Values of sFlt-1 and PlGF were measured postpartum using the automated Elecsys system to prevent influence of this information on decision-making of the treating physicians and the defining time point of delivery. Clinical characteristics and pregnancy outcomes were retrieved from medical records. Cutoffs of < 33 to rule out and >85 to rule in the occurrence of delivery for selected time points were used.Complete data of 299 patients (age 18 to 48 yrs. singleton pregnancies, median pregnancy duration 35 weeks (range 20–41 weeks) are available. At time of inclusion 70 pregnancies were complicated with PE, 25 with superimposed PE, 8 with HELLP, 80 with gestational hypertension (GH) and 116 without pregnancy induced hypertension. Delivery within 7 days occurred in 66% of patients with a ratio >85 compared to 27% with a ratio <33 (P < 0.0001) and 29% with a ratio 33–85 (P = 0.0095). The median (range) ratio in patients who delivered within 7 days was 133 (12–1896) compared to 19 (1–498) in those who delivered after 7 days (P < 0.0001). Furthermore, ROC analysis showed that both ratio (AUC 0.88) and PlGF alone (AUC 0.91) exhibited a superior performance to the clinical diagnosis (AUC 0.72) in predicting adverse outcomes (P = 0.0021 and < 0.0001, respectively). Surprisingly PlGF was as good as the ratio for predicting adverse outcome of pregnancy.In this high risk group a low ratio is inversely correlated with prolongation and adverse outcome of pregnancy. Ratio is superior to clinical diagnoses of PE for both predicting prolongation and adverse outcome of pregnancy.