Comprehensive preeclampsia management for all trimesters

Timing matters more than ever.

When it comes to preeclampsia prevention, the earlier you identify women as having a high risk for developing the condition, the better the outcome for mother and child. Based on evidence from research studies, such as the ASPRE study, a combined screening program is recommended at 11–13 weeks’ gestation to identify women at high risk of preeclampsia, when steps can still be taken to prevent its onset.

Any woman can be at high risk

All women should have access to screening, even if there are no maternal risk factors or history of preeclampsia. Being able to predict preterm preeclampsia early in the pregnancy is key to its prevention.

Specific marker for pre-eclampsia – PIGF

In pregnancies that develop preeclampsia, maternal serum placental growth factor (PlGF) levels decrease significantly in the first trimester. This makes it an important biomarker used to predict the onset of preeclampsia. Our high-sensitivity PlGF 1-2-3™ assay is optimized for first trimester screening of preeclampsia, and is the only assay which has been clinically validated by the ASPRE trial.

Reducing the risk of pre-eclampsia.

Clinicians can recommend prophylactic aspirin treatment to women identified as having high risk of preeclampsia through screening aimed at preventing pre-eclampsia or, at least, delaying its onset. The Aspirin for Evidence-Based Preeclampsia Prevention (ASPRE) study showed that simple treatment with a daily dose of aspirin — 150mg taken each night — significantly reduces the risk of preterm preeclampsia in pregnant women when started during the first trimester of pregnancy. (Aspirin should only be used for preventive care by women screened and found to be at high risk for preterm pre-eclampsia.)

Record medical history, height and weight

Certain factors are known to increase the risk of preeclampsia, so as part of combined preeclampsia screening, so it’s important to determine and document any background risks, including previous or family history of preeclampsia, ethnicity, chronic hypertension and smoking.

Take Blood Sample for PIGF Test

Our high-sensitivity PlGF 1-2-3™ assay can be utilized for the measurement of maternal serum placental growth factor for pre-eclampsia in the first trimester. Our PAPP-A assay has also been validated as an alternative or addition for preeclampsia 1st trimester screening. The same blood sample can be used for both preeclampsia screening and aneuploidy screening using the same instrument and markers; no additional blood sample is required.

Measure blood pressure

In the prediction of preeclampsia, the calculated MAP (systolic blood pressure – diastolic blood pressure)/3 + diastolic blood pressure) can be a useful marker. For these readings, two measurements are taken from both arms simultaneously using two automated blood pressure monitors.

Measure Pulsatility Index

Additionally the uterine artery pulsatility index can be measured via transvaginal or transabdominal ultrasound. (Combined pre-eclampsia screening without the pulsatility index is still a good option if access to ultrasound is limited.)

Screening for maternal serum concentrations

Women with signs or symptoms of preeclampsia do not always develop preeclampsia. Angiogenic markers can be used to help identify women with increased risk for developing preeclampsia in the coming days.

After 20 weeks of pregnancy PlGF and sFlt-1 are both predictive and diagnostic for preeclampsia. These biomarkers can be used to identify high risk women that are likely to develop preterm  preeclampsia later in their pregnancy and to predict the onset of preeclampsia. Biomarker levels are also found to be correlating with severity of disease.

Determining serum PlGF concentration, used as a single marker, or sFlt-1 and PlGF, used as a ratio, improve the clinical management and decision making (risk stratification) with women showing signs and symptoms of preeclampsia.

Two alternatives – PlGF as a single marker or sFlt-1/PlGF ratio

PlGF alone and sFlt-1/PlGF ratio have comparable performance for preeclampsia rule-in and rule-out, and both options are equally recommended for clinical use.  However, PLGF alone, with concentration based cut-offs, could provide simpler and more affordable alternative to dual biomarker testing.

Using PlGF has additional advantages. Studies have shown that PlGF is a good marker (decreased serum PlGF level) for identifying pregnancies with placental insufficiency including fetal growth restriction and/or stillbirth.

LifeCycle™ software enables monitoring of preeclampsia status with PlGF concentration or the sFlt-1/PlGF ratio. The results can be linked to the patient case in LifeCycle™ software allowing the user to view all available results in one place. The assay cut-offs for  preeclampsia management are user configurable.