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

Published:October 05, 2021DOI:https://doi.org/10.1016/j.ejogrb.2021.10.006
Implementing placental-growth-factor (PLGF) measurements in suspected pre-eclampsia----Challenges in clinical practice
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      Abstract

      Objectives

      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.

      Results

      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).

      Conclusions

      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.

      Abbreviations:

      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)

      Keywords

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      References

        • Vatten L.J.
        • Skjaerven R.
        Is pre-eclampsia more than one disease?.
        BJOG An Int J Obstet Gynaecol. 2004; 111: 298-302https://doi.org/10.1111/bjo.2004.111.issue-410.1111/j.1471-0528.2004.00071.x
        View in Article
        • North R.A.
        • Taylor R.S.
        • Schellenberg J.-C.
        Evaluation of a definition of pre-eclampsia.
        BJOG An Int J Obstet Gynaecol. 1999; 106: 767-773https://doi.org/10.1111/bjo.1999.106.issue-810.1111/j.1471-0528.1999.tb08396.x
        View in Article
        • Hutcheon J.A.
        • Lisonkova S.
        • Joseph K.S.
        Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy.
        Best Pract Res Clin Obstet Gynaecol. 2011; 25: 391-403https://doi.org/10.1016/j.bpobgyn.2011.01.006
        View in Article

      4. Macdonald-Wallis C, Lawlor DA, Heron J, Fraser A, Nelson SM, Tilling K. Relationships of risk factors for pre-eclampsia with patterns of occurrence of isolated gestational proteinuria during normal term pregnancy. PLoS One 2011;6. https://doi.org/10.1371/journal.pone.0022115.

        View in Article
        • Henderson J.T.
        • Thompson J.H.
        • Burda B.U.
        • Cantor A.
        Preeclampsia Screening.
        JAMA. 2017; 317: 1668https://doi.org/10.1001/jama.2016.18315
        View in Article
        • Hermida R.C.
        • Ayala D.E.
        Diagnosing gestational hypertension and preeclampsia with the 24-hour mean of blood pressure.
        Hypertension. 1997; 30: 1531-1537https://doi.org/10.1161/01.HYP.30.6.1531
        View in Article
        • Morris R.K.
        • Riley R.D.
        • Doug M.
        • Deeks J.J.
        • Kilby M.D.
        Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: Systematic review and meta-analysis.
        BMJ. 2012; 345 (e4342-e4342)https://doi.org/10.1136/bmj.e4342
        View in Article
        • Duhig K.E.
        • Seed P.T.
        • Myers J.E.
        • Bahl R.
        • Bambridge G.
        • Barnfield S.
        • et al.
        Placental growth factor testing for suspected pre-eclampsia: a cost-effectiveness analysis. BJOG An Int.
        J Obstet Gynaecol. 2019; 126: 1390-1398https://doi.org/10.1111/bjo.v126.1110.1111/1471-0528.15855
        View in Article
        • Fox A.
        • McHugh S.
        • Browne J.
        • Kenny L.C.
        • Fitzgerald A.
        • Khashan A.S.
        • et al.
        Estimating the Cost of Preeclampsia in the Healthcare System.
        Hypertension. 2017; 70: 1243-1249https://doi.org/10.1161/HYPERTENSIONAHA.117.09499
        View in Article
        • Wagner L.K.
        Diagnosis and management of preeclampsia.
        Am Fam Physician. 2004; 70
        View in Article
        • Cerdeira A.S.
        • O’Sullivan J.
        • Ohuma E.O.
        • Harrington D.
        • Szafranski P.
        • Black R.
        • et al.
        Randomized Interventional Study on Prediction of Preeclampsia/Eclampsia in Women with Suspected Preeclampsia: INSPIRE.
        Hypertension. 2019; 74: 983-990https://doi.org/10.1161/HYPERTENSIONAHA.119.12739
        View in Article
        • Zeisler H.
        • Llurba E.
        • Chantraine F.
        • Vatish M.
        • Staff A.C.
        • Sennström M.
        • et al.
        Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia.
        N Engl J Med. 2016; 374: 13-22https://doi.org/10.1056/NEJMoa1414838
        View in Article
        • Levine R.J.
        • Maynard S.E.
        • Qian C.
        • Lim K.-H.
        • England L.J.
        • Yu K.F.
        • et al.
        Circulating Angiogenic Factors and the Risk of Preeclampsia.
        N Engl J Med. 2004; 350: 672-683https://doi.org/10.1056/NEJMoa031884
        View in Article

      14. National Institute for Health and Care Excellence. 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). Https://WwwNiceOrgUk/Guidance/Dg23/Chapter/1-Recommendations 2016. https://www.nice.org.uk/guidance/dg23 (accessed July 2, 2021).

        View in Article
        • Dröge L.A.
        • Perschel F.H.
        • Stütz N.
        • Gafron A.
        • Frank L.
        • Busjahn A.
        • et al.
        Prediction of Preeclampsia-Related Adverse Outcomes with the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor)-Ratio in the Clinical Routine: A Real-World Study.
        Hypertension. 2021; 77: 461-471https://doi.org/10.1161/HYPERTENSIONAHA.120.15146
        View in Article
        • Bian X.
        • Biswas A.
        • Huang X.
        • Lee K.J.
        • Li T.-T.
        • Masuyama H.
        • et al.
        Short-Term Prediction of Adverse Outcomes Using the sFlt-1 (Soluble fms-Like Tyrosine Kinase 1)/PlGF (Placental Growth Factor) Ratio in Asian Women with Suspected Preeclampsia.
        Hypertension. 2019; 74: 164-172https://doi.org/10.1161/HYPERTENSIONAHA.119.12760
        View in Article
        • Caillon H.
        • Tardif C.
        • Dumontet E.
        • Winer N.
        • Masson D.
        Evaluation of sFlt-1/PlGF ratio for predicting and improving clinical management of pre-eclampsia: Experience in a specialized perinatal care center. Ann.
        Lab Med. 2018; 38: 95-101https://doi.org/10.3343/alm.2018.38.2.95
        View in Article

      18. National Institute for Health and Care Excellence. Review of DG23: PLGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFlt1/PLGF ratio, DELFIA Xpress PLGF 1-2-3 test, and BRAHMS sFlt-1 Kryptor/BRAHMS PLGF plus Kryptor PE ratio). Cent Heal Technol Eval 2016. https://www.nice.org.uk/guidance/dg23/evidence/review-decision-february-2020-pdf-8830114525 (accessed June 15, 2021).

        View in Article

      19. National Health Service England, National Health Service Improvement. Innovation and Technology Payment - Technical Notes 2020. https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2020/12/PAR0091-itp-technical-guidance-20-20-v8.pdf (accessed July 21, 2021).

        View in Article

      20. Sucheta Jindal. PlGF ratio in the management of suspected Pre-eclampsia 2020.

        View in Article

      21. National Institute for Health and Care Excellence Clinical Knowledge Summaries. Hypertension in Pregnancy 2020. https://cks.nice.org.uk/topics/hypertension-in-pregnancy/ (accessed July 21, 2021).

        View in Article
        • Stepan H.
        • Herraiz I.
        • Schlembach D.
        • Verlohren S.
        • Brennecke S.
        • Chantraine F.
        • et al.
        Implementation of the sFlt-1/PlGF ratio for prediction and diagnosis of pre-eclampsia in singleton pregnancy: Implications for clinical practice.
        Ultrasound Obstet Gynecol. 2015; 45: 241-246https://doi.org/10.1002/uog.14799
        View in Article
        • Leaños-Miranda A.
        • Graciela Nolasco-Leaños A.
        • Ismael Carrillo-Juárez R.
        • José Molina-Pérez C.
        • Janet Sillas-Pardo L.
        • Manuel Jiménez-Trejo L.
        • et al.
        Usefulness of the sFlt-1/PlGF (Soluble fms-Like Tyrosine Kinase-1/Placental Growth Factor) Ratio in Diagnosis or Misdiagnosis in Women with Clinical Diagnosis of Preeclampsia.
        Hypertension. 2020; 76: 892-900https://doi.org/10.1161/HYPERTENSIONAHA.120.15552
        View in Article

      24. National Institute for Health and Care Excellence. Resource Impact Template: PIGF-based testing to help diagnose suspected pre-eclampsia 2016. https://www.nice.org.uk/guidance/dg23/resources (accessed July 21, 2021).

        View in Article
        • Brown M.A.
        THE PHYSIOLOGY OF PRE-ECLAMPSIA.
        Clin Exp Pharmacol Physiol. 1995; 22: 781-791https://doi.org/10.1111/cep.1995.22.issue-1110.1111/j.1440-1681.1995.tb01937.x
        View in Article
        • Audette M.C.
        • Kingdom J.C.
        Screening for fetal growth restriction and placental insufficiency.
        Semin Fetal Neonatal Med. 2018; 23: 119-125https://doi.org/10.1016/j.siny.2017.11.004
        View in Article

      27. National Health Service. MedTech Funding Mandate policy 2021/22 2021. https://www.england.nhs.uk/aac/wp-content/uploads/sites/50/2021/01/mtfm-policy-guidance-jan-2021.pdf (accessed July 21, 2021).

        View in Article
        • Stepan H.
        • Schlembach D.
        • Ramoni A.
        • Bahlmann F.
        • van der Does R.
        • Messinger D.
        • et al.
        PreOS (Preeclampsia Open Study), a Multicenter, Prospective, Non-Interventional Study Evaluating the Influence of the sFlt-1/PlGF Ratio on Physician Decision-Making in Pregnant Women with Suspicion of Preeclampsia.
        Geburtshilfe Frauenheilkd. 2015; 75https://doi.org/10.1055/s-0000002010.1055/s-005-2896510.1055/s-0035-1548683
        View in Article
        • Vatish M.
        • Strunz‐McKendry T.
        • Hund M.
        • Allegranza D.
        • Wolf C.
        • Smare C.
        sFlt-1/PlGF ratio test for pre-eclampsia: an economic assessment for the UK.
        Ultrasound Obstet Gynecol. 2016; 48: 765-771https://doi.org/10.1002/uog.2016.48.issue-610.1002/uog.15997
        View in Article
        • Sá C.P.N.d.
        • Jiménez M.F.
        • Rosa M.W.
        • Arlindo E.M.
        • Ayub A.C.K.
        • Cardoso R.B.
        • et al.
        Evaluation of Angiogenic Factors (PlGF and sFlt-1) in Pre-eclampsia Diagnosis.
        Rev Bras Ginecol e Obstet. 2020; 42: 697-704https://doi.org/10.1055/s-0040-1713916
        View in Article
        • Duckworth S.
        • Chappell L.C.
        • Seed P.T.
        • Mackillop L.
        • Shennan A.H.
        • Hunter R.
        • et al.
        Placental growth factor (PLGF) in women with suspected pre-eclampsia prior to 35 weeks’ gestation: A budget impact analysis.
        PLoS ONE. 2016; 11: e0164276https://doi.org/10.1371/journal.pone.0164276
        View in Article

      Article info

      Publication history

      Published online: October 05, 2021
      Accepted: October 1, 2021
      Received in revised form: September 29, 2021
      Received: September 4, 2021

      Identification

      DOI: https://doi.org/10.1016/j.ejogrb.2021.10.006

      Copyright

      © 2021 Elsevier B.V. All rights reserved.

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