Tools and resources

1 Introduction

1 Introduction

This resource has been developed to provide practical information and advice relating to NICE diagnostic guidance on PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFlt-1/PlGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor/BRAHMS PlGF plus Kryptor PE ratio). It is intended to be used by clinical staff and those responsible for commissioning and managing maternity services, who are planning to implement the guidance and start using this technology.

During the development of the diagnostic guidance, 4 placental growth factor (PlGF)-based testing technologies were considered for ruling in or ruling out pre-eclampsia, but not for managing or diagnosing placental disease. The guidance recommended the following 2 of the 4 technologies to help rule out pre-eclampsia:

PlGF-based tests are currently used alongside clinical judgement in a few NHS organisations to help diagnose suspected pre-eclampsia. NICE's adoption team worked with NHS clinicians, with experience in using the Triage PlGF and Elecsys immunoassay sFlt‑1/PlGF ratio tests, to share their learning of planning the adoption of this guidance.

The information presented in this resource is intended for the sole purpose of supporting the NHS in adopting, evaluating the impact of adopting or further researching this technology. It is complementary to the guidance and was not considered by the diagnostics advisory committee when developing its recommendations.

Pre-eclampsia, a potentially serious complication of some pregnancies, may be related to problems with the development of the placenta. If not diagnosed and closely monitored, pre-eclampsia can lead to life-threatening complications.

PlGF-based tests measure the amount of PlGF in blood plasma or serum. PlGF is a protein involved in placental angiogenesis (the development of new blood vessels). In pre-eclampsia, levels of PlGF can be abnormally low. In normal pregnancy, PlGF levels rise until they peak at 26–30 weeks. When PlGF levels do not rise during pregnancy there may be placental dysfunction. Some PlGF-based tests also measure soluble FMS‑like tyrosine kinase‑1 (sFlt‑1), a protein that may disable other proteins associated with blood vessel formation, such as PlGF. In women who develop pre-eclampsia, the levels of sFlt‑1 are higher than those seen in normal pregnancy.

The potential benefits of using PlGF-based tests as reported by the NHS staff involved in producing this resource include:

  • helping to make a decision on the appropriate patient pathway

  • providing reassurance to clinicians and pregnant women who are sent home with an appointment for follow-up at a clinic, that they do not have pre-eclampsia at that point

  • helping to reduce hospital admissions solely for monitoring

  • helping to identify appropriate surveillance frequency when pre-eclampsia is ruled out.

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