In the last year, more than 40,000 pregnant women have benefited from innovative tests for pre-eclampsia.
Pre-eclampsia is a common yet serious condition and complicates up to 1 in 20 pregnancies. It is a high blood pressure disorder that is more likely to develop in the second half of pregnancy. There is no cure, but diagnosing the condition early allows closer monitoring. In some cases, early delivery of the baby is necessary to reduce the risk of complications for both mother and baby. Around 10% of pregnant women have symptoms of the condition, while only around 3% actually have pre-eclampsia.
As the delivery arm of the Accelerated Access Collaborative’s (AAC) Rapid Uptake Products (RUP) programme and the new MedTech Funding Mandate, the AHSNs have been supporting the rollout of Placental Growth Factor (PlGF) tests.
PlGF is a molecule made by the placenta. A low-level of PlGF indicates a poorly functioning placenta and a higher risk of developing severe pre-eclampsia. A PlGF-based blood test can reduce the time to diagnose pre-eclampsia from four to two days. This quicker diagnosis reduces delays in arranging treatment for women most at risk of developing severe complications and removes unnecessary monitoring for those who are not at risk.
PlGF-based testing at Manchester University NHS Foundation Trust (MFT)
Jenny Myers is a Professor of Obstetrics and Maternal Medicine at The University of Manchester, and a Consultant Obstetrician at Saint Mary’s Hospital – part of Manchester University NHS Foundation Trust (MFT). She is a clinical champion and advocate for PlGF-based testing and was involved in some of the initial research studies to evidence the impact of using the test to support the diagnosis of pre-eclampsia.
“I’m a real advocate for the test as it makes such a big difference to women. It transforms care in lots of situations.
“In terms of ruling out pre-eclampsia, there will be lots of women that come to us with a high blood pressure reading at some point during their pregnancy and although this is a potential sign of pre-eclampsia, in many cases the woman isn’t developing pre-eclampsia. If the PlGF-based test is normal, then we can be confident that pre-eclampsia is not developing over the next 7-14 days and we can safely let that woman go back to her routine antenatal surveillance. Most importantly we can reassure her that everything is looking fine.
“When we have women with an abnormal test, it gives us lots more information to work with. We are finding that we make the diagnosis much earlier than if we were to wait for all of the clinical signs of pre-eclampsia to develop, by which point the patient or baby could already be quite poorly.
“Using the test has a positive impact for clinicians too. Adding the blood test to the overall assessment focuses the clinician on the purpose of the assessment and the need to rule in or rule out pre-eclampsia. The test can act as a prompt to the clinical team to make a diagnosis and plan the appropriate ongoing care for that individual woman.”
“We were very lucky at our Trust as we had been involved in the initial research study to gather evidence on PlGF-based testing, so it wasn’t new to us when it was introduced as part of the Innovation and Technology Payment (ITP) programme.
“At the start, we introduced guidelines based on those created by National Institute for Health and Care Excellence (NICE), for using the test in women who were at risk of developing pre-eclampsia. We have pathways that advise when a woman should get the test and it is now part of our routine assessment if pre-eclampsia is suspected”.
Jenny works closely with her regional AHSN Health Innovation Manchester as a clinical champion for PlGF-based testing, working with other trusts and clinicians across Lancashire and Greater Manchester to encourage and support the implementation of the test.
“Our regional AHSN has been absolutely instrumental in delivering this test to the women of Greater Manchester and without the AHSN we simply wouldn’t have achieved implementation on such a scale. We’ve worked very closely together in terms of supporting hospitals and creating networks.
“Working with the AHSN helps us spread best practice beyond Greater Manchester and into other regions. We can share guidelines, pathways, business cases, amongst other things. We connected much more effectively by working together.
“For trusts that are looking to implement PlGF-based testing, my main advice would be to find a dedicated and motivated clinician to champion it within the hospital. That may be a midwife, a clinical biochemist or a consultant obstetrician. A motivated person on the ground working with all the different parts of the hospital is essential.”
Following the evidence generated about PlGF-based testing, further research is currently being undertaken to understand the role of repeat PlGF-based testing to rule out or rule in pre-eclampsia (PARROT 2 study). As part of the study, led by Professor Chappell at Kings College London, women are currently being recruited within MFT’s Saint Mary’s Hospital, in addition to many other hospitals around the country.
 April 2020–end of March 2021