Clinical Report: Pre-eclampsia Care: Let's Make it Proactive

Overview

Pre-eclampsia affects approximately 1 in 25 pregnancies in the UK and is a leading cause of maternal and perinatal mortality. The introduction of placental growth factor (PlGF) testing has been recommended for improving early diagnosis and clinical decision-making for at-risk pregnancies.

Background

Pre-eclampsia is a significant hypertensive disorder that can lead to severe complications for both mothers and infants. Traditional diagnostic methods often fail to identify at-risk patients early enough, resulting in delayed interventions. PlGF testing provides insights into placental health.

Data Highlights

Research has found that PlGF testing can reduce the time to diagnosis of pre-eclampsia and improve clinical decision-making in triage settings.

Key Findings

• Pre-eclampsia affects around 1 in 25 pregnancies in the UK.
• Standard care testing often fails to identify at-risk patients until symptoms are present.
• PlGF levels decrease significantly in women who will develop pre-eclampsia, often weeks before clinical signs appear.
• NICE first recommended PlGF-based testing for suspected pre-eclampsia in 2016, with updates in 2022.
• Implementation of PlGF testing is inconsistent across NHS trusts, with significant regional variations.
• Barriers to adoption include operational challenges and the need for cultural shifts in clinical practice.

Clinical Implications

The integration of PlGF testing into standard triage protocols could enhance the identification of women at risk for pre-eclampsia.

Conclusion

PlGF testing is a recommended approach in the management of pre-eclampsia, highlighting the need for improved infrastructure and training within clinical workflows.

Related Resources & Content

1. BMC Pregnancy and Childbirth, 2023 -- Abnormal renal function three months after delivery among pre-eclampsia survivors in Sub-Saharan Africa: a prospective cohort study in Uganda
2. BMC Pregnancy and Childbirth, 2023 -- Identifying biomarkers of the serum proteins and metabolites associated with severe preeclampsia
3. Frontiers in Medicine, 2023 -- Rethinking preeclampsia: six paradigm shifts in placental pathophysiology for maternal–foetal medicine
4. NICE, 2023 -- Overview | Hypertension in pregnancy: diagnosis and management | Guidance
5. ACOG, 2024 -- Clinical Practice Update: Biomarker Prediction of Preeclampsia With Severe Features - SMFM Publications and Clinical Guidelines
6. BMC Pregnancy and Childbirth — The use of the first trimester (AST × LDH × urea) / (platelet × hemoglobin) index in the prediction of preeclampsia
7. Placental Growth Factor Testing for Faster Preeclampsia Diagnosis
8. Overview | Hypertension in pregnancy: diagnosis and management | Guidance | NICE
9. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice
10. ACOG Clinical Practice Update: Biomarker Prediction of Preeclampsia With Severe Features - SMFM Publications and Clinical Guidelines
11. Repeat placental growth factor-based testing in women with suspected preterm pre-eclampsia (PARROT-2): a multicentre, parallel-group, superiority, randomised controlled trial - ScienceDirect
12. Randomized Interventional Study on Prediction of Preeclampsia/Eclampsia in Women With Suspected Preeclampsia: INSPIRE - PMC
13. Predictive performance of sFlt-1, PlGF and the sFlt-1/PlGF ratio for preeclampsia: A systematic review and meta-analysis - ScienceDirect