New Tests for Pre-eclampsia?
Pre-eclampsia is a complication of pregnancy which can have serious consequences for both mother and baby if left unrecognised or untreated. It is thought to be related to problems with the development of the placenta and occurs in around 5% of pregnancies.
A new blood test (known as PLGF based tests) indicates whether the women has the disease and when used in women with suspected pre-eclampsia can reliably indicate who will need delivery soon. It is a reliable test of whether the baby is at risk. This test can be used to indicate who needs admission and intensive monitoring to determine when delivery is required, or who can be discharged home. Many other tests can frequently be avoided and it is therefore cost effective. There are currently 3 versions of these tests available in the UK. All of them measure PLGF, and one also measures SFlt, and uses it as a ratio with PLGF. The PLGF is not the same in each assay, as there are 4 subtypes (isoforms) and each assay measures them differently. Each test is equally valuable, but has different levels to indicate action.
These tests will be available in the NHS, and the clinicans will be aware of which values to use. If the test is normal in women with worrying features, it is unlikely that pre-eclampsia will develop. If the test is abnormal, then more monitoring can be instigated to both mother and baby and delivery arranged when appropriate. Blood pressure may be treated in the meantime and drugs (magnesium sulphate) given while delivery is being arranged. At the moment PLGF based tested are not used to determine who needs delivery, or how severe the pre-eclampsia.
The PHOENIX trial is a non-masked, randomised controlled trial, comparing planned early delivery (with initiation of delivery within 48 h of randomisation) with usual care (expectant management) in women with pre-eclampsia between 34+ 0 and 36+ 6 weeks’ gestation. The primary objectives of the trial are to determine if planned delivery reduces adverse maternal outcomes, without increasing the short-term harm to infants (composite of perinatal deaths or neonatal unit admissions up to infant hospital discharge) or impacting long-term infant neurodevelopmental status at 2 years corrected age (Parent Report of Cognitive Abilities-Revised).
New NHS Long Term plan – Summary for Maternal and Neonatal Care
This paper distils the key points of the NHS Long Term Plan, launched on January 7th 2019, which can be downloaded, along with supporting papers from longtermplan.nhs.uk. We have aimed in this short paper to take the key points and reproduce them here without comment and “as is” within the Long Term Plan. This is designed for clinicians, the public and anyone interested in what the plan is for maternity services, but may not have time to go through all 120 pages of the plan.
Reducing maternal deaths from hypertensive disorders: learning from confidential inquiries
Confidential inquiries into maternal deaths in the UK were established in 1952 and have aimed to report on every pregnancy related death since then Maternal deaths from hypertensive disorders of pregnancy have reduced dramatically in the UK over the past 60 years Incremental improvement in clinical management and organisation of care through recommendations made in the confidential inquiry reports and publication of national guidelines are likely to have driven much of this decline in recent decades To tackle global maternal mortality related to hypertensive disorders, setting up a confidential inquiry is an important first step for many countries Almost complete eradication of maternal mortality related to hypertensive disorders of pregnancy seems possible.
Placental growth factor testing to assess women with suspected pre-eclampsia:
Previous prospective cohort studies have shown that angiogenic factors have a high diagnostic accuracy in women with suspected pre-eclampsia, but we remain uncertain of the effectiveness of these tests in a real-world setting. We therefore aimed to determine whether knowledge of the circulating concentration of placental growth factor (PlGF), an angiogenic factor, integrated with a clinical management algorithm, decreased the time for clinicians to make a diagnosis in women with suspected pre-eclampsia, and whether this approach reduced subsequent maternal or perinatal adverse outcomes.