Pure preeclampsia at 16 weeks of gestation with an increasing trend of sFlt-1/PlGF ratio: A case report and literature review

A 47-year-old nulliparous woman with no significant medical history underwent a preimplantation genetic diagnosis and received a transfer of an embryo after egg donation. At 16 + 1 weeks of gestation, she developed preeclampsia with hypertension and proteinuria, which gradually worsened with symptoms like hemolysis, elevated liver enzyme levels, and fetal growth restriction without anomaly. No underlying autoimmune diseases and secondary hypertension symptoms were detected. The patient underwent an emergency cesarean section at 22 + 3 weeks of gestation following intrauterine fetal death and a severe maternal condition. The maternal condition improved significantly post-delivery, with placental pathology revealing no molar changes. Pure preeclampsia, characterized by the absence of underlying maternal disease, fetal chromosomal abnormalities, or molar pregnancy before 20 weeks of gestation, is extremely rare. Here, we report a case of pure preeclampsia occurring at 16 weeks of gestation with an increasing trend of soluble fms-like tyrosine kinase 1/ placental growth factor ratio and provide a review of relevant literature.