Full length article| Volume 266, P157-162, November 2021

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Implementing placental-growth-factor (PLGF) measurements in suspected pre-eclampsia----Challenges in clinical practice

Published:October 05, 2021DOI:



      As a part of NHS’ Innovation and Technology Payment programme (ITP), pregnant women were offered Placental Growth Factor (PLGF)-based testing to help rule out pre-eclampsia (PET) – a serious condition that affects approximately 2.3% of the female population. The study was aimed to evaluate the implementation of PLGF-based testing at United Lincolnshire Trust Hospitals (ULHT).

      Study Design

      The soluble FMS like Tyrosine kinase 1/placental growth factor (sFlt-1/PLGF) ratio test was launched at ULHT on 8th October 2020. The project involved a review of an electronic maternity database (MEDWAY) for all women who had sFLT-1/PLGF ratio test performed at ULHT over a 5-month period (October 2020-February 2021). The sFlt-1/PLGF ratio was recorded alongside clinical outcome. Women were classified as low, moderate, and high risk for development of PET if the sFlt-1/PLGF ratio was ≤ 38, 39–84 and ≥ 85 respectively. Reasons for admission were further investigated and adherence to the sFLT-1/PLGF protocol was monitored to evaluate staff performance. Data was then statistically analysed with χ2 and T-test for categorical and continuous variables respectively. Finally, sensitivity and specificity of the sFLT-1/PLGF was assessed with an ROC curve.


      A total of 236 women had sFlt-1/PLGF ratio test performed in a five-month period. A two-time point analysis (a “during implementation” and “post implementation phase”) showed a significant decrease in the admission rates in the post-implementation phase in low-risk group (28.5% during implementation vs 11.3% post-implementation, P < 0.05). Further analysis showed greater staff adherence to the sFLT-1/PLGF protocol in the post-implementation period. The high-risk group demonstrated shorter time from test to delivery, earlier gestational age at delivery and lower birth weight (P < 0.05).


      The study outcomes resulted in a successful submission of a business case. Successful triage of low-risk women at the point where historically admissions were considered reduced clinical workload and enabled better utilisation of resources by allowing focussed care on high-risk women for an optimal maternal and perinatal outcome.


      NICE CKS (National Institute for Health and Care Excellence Clinical Knowledge Summaries), NICU (Neonatal Intensive Care Unit), NHS (National Health Service), PET (Pre-eclampsia), PLGF (Placental growth factor), ROC (Receiver-operating characteristic), sFLT-1 (Soluble FMS-like Tyrosine Kinase-1), UK (United Kingdom), ULHT (United Lincolnshire Hospital Trust)


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