PLGF Point of Care Test for Detection of Preeclampsia
Background to the Project
Diagnosis of pregnant women with preeclampsia is currently based on clinical features such as hypertension and raised urinary protein excretion, both of which are subject to observer error. Risk stratification of women with suspected pre-eclampsia is complex. This ambiguity leads to repeated hospital attendances for antenatal monitoring, increased use of health resources, and considerable anxiety for women, whilst missing at-risk cases.
Recent research (PARROT trial) has shown that, in women presenting with suspected pre-eclampsia before 36 weeks gestation, PlGF measurement on Quidel Triage MeterPro, incorporated into a management algorithm based on national guidelines, significantly reduces the time taken for treating clinicians to accurately diagnose pre-eclampsia. Through collaboration with Quidel and the clinical pathology team at Wrexham, we successfully submitted a business case to the Health Board in December 2020 to introduce POCT during the Covid pandemic. We trained midwifery and doctors on how to use it, set up a space in the clean utility room in the day assessment unit and introduced it into the WCD guidelines for BCUHB. Currently audit is in process to assess the clinical utility, patient satisfaction and financial impact.
How this will be achieved
The next stage of the project will be to present our audit and demonstrate patient benefits and financial impact. We are pioneering PLGF in Wales and want to introduce it into our 2 sister hospital sites and then into South Wales. We hope to incorporate findings of PARROT -2 trial and secure funding to sustain this service.
PlGF testing will lead to:
- Faster diagnosis of preeclampsia (1.9 vs 4.1 days; 64% reduction)
- Fewer out-patient visits (6.1 vs 9.4; 35% reduction)
- Less neonatal care (intensive and high-dependency care nights; 15·2 vs 24·2 nights; 37% reduction)
- Timely triage of patients results in improved flow through maternity services
- Reduce pressure on labs as less associated testing required when PlGF is normal
- Demonstrated acceptability and satisfaction for patients and staff
- Improved patient safety
NICE DG23 and CG107 recommends the use of this test to ‘rule-out’ pre-eclampsia in those presenting with suspected clinical symptoms.
All 4 Prudent Healthcare Principles are met as a result of this project.