Comprehensive pre-eclampsia management for all trimesters
Saving mothers and babies through earlier screening and better care
Pre-eclampsia is a pregnancy complication affecting between two and eight out of every 100 pregnant women.
The exact cause is unknown, but its risks are clear: left untreated, pre-eclampsia can cause growth-restriction or preterm birth of the child, and in some cases, lead to maternal and perinatal mortality. But with screening, the high risk of the more severe forms of pre-eclampsia, early-onset and preterm pre-eclampsia, can be predicted and prevented.
Women around the world develop pre-eclampsia annually
Pre-term births are caused by pre-eclampsia each year
Babies die every year due to pre-eclampsia
Women die every year due to pre-eclampsia
Prediction and prevention
When should women be screened for pre-eclampsia?
Timing matters more than ever.
When it comes to pre-eclampsia 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 pre-eclampsia, when steps can still be taken to prevent its onset.
Who should be screened for pre-eclampsia?
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 pre-eclampsia. Being able to predict preterm pre-eclampsia early in the pregnancy is key to its prevention.
Pre-eclampsia screening markers
Specific marker for pre-eclampsia – PIGF
In pregnancies that develop pre-eclampsia, 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 pre-eclampsia. PerkinElmer’s high-sensitivity PlGF 1-2-3™ assay is optimized for first trimester screening of pre-eclampsia, and is the only assay which has been clinically validated by the ASPRE trial.
Low dose aspirin for preventive care
Reducing the risk of pre-eclampsia.
Clinicians can recommend prophylactic aspirin treatment to women identified as having high risk of pre-eclampsia 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 pre-eclampsia 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.)
The Combined Screening Program
Based on the evidence from research studies, international guidelines are recommending a combined screening program for pre-eclampsia at 11-13+6 weeks as the most effective way to identify women at high risk of pre-eclampsia in the early stages of pregnancy.
The combined screening program is made up of four simple steps that require short training and minimal additional investment in equipment. PerkinElmer’s Lifecycle Software™ can generate a unique patient risk profile and report based on these combined screening markers.
Record medical history, height and weight
Certain factors are known to increase the risk of pre-eclampsia, so as part of combined pre-eclampsia screening, so it’s important to determine and document any background risks, including previous or family history of pre-eclampsia, ethnicity, chronic hypertension and smoking.
Take Blood Sample for PIGF Test
PerkinElmer’s 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. PerkinElmer’s PAPP-A assay has also been validated as an alternative or addition for pre-eclampsia 1st trimester screening. The same blood sample can be used for both pre-eclampsia screening and aneuploidy screening using the same instrument and markers; no additional blood sample is required.
Measure blood pressure
In the prediction of pre-eclampsia, 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.)
DELFIA® Xpress random access platform
AutoDELFIA® immunoassay system
What is the sFlt-1/PlGF ratio?
Screening for maternal serum concentrations
During the second and third trimesters, sFlt-1 is used with PlGF as predictive and diagnostic markers for pre-eclampsia; it’s been shown that increased levels of sFlt-1 and decreased levels of PlGF in maternal serum can predict the subsequent onset of pre-eclampsia. These levels are used as a ratio to help confirm clinical suspicion of pre-eclampsia with symptomatic women.
When should I determine the sFlt-1/PlGF ratio?
Diagnosis and prognosis
Testing for the sFlt-1/PlGF ratio is applicable to women with signs and symptoms of pre-eclampsia after week 20 of gestation. In addition to confirming or excluding diagnosis of pre-eclampsia, sFlt-1 and PlGF levels are also found to correlate with the severity of the condition, so monitoring for changes in the ratio can be used to improve clinical management and decision making.
Prenatal screening software
Monitoring for improved diagnosis and prognosis
Our LifeCycle™ software enables easy monitoring of pre-eclampsia status with the sFlt-1/PlGF ratio, and the ratio results can be linked to the same patients’ other results, so you can follow the patient from 1T pre-eclampsia risk assessment to 2T/3T pre- eclampsia management.
2T & 3T Pre-Eclampsia Management Products
DELFIA® Xpress random access platform
AutoDELFIA® immunoassay system
More information on pre-eclampsia
Pre-eclampsia Learning & Resources
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PerkinElmer does not endorse or make recommendations with respect to research, medication, or treatments. All information presented is for informational purposes only and is not intended as medical advice. For country specific recommendations please consult your local health care professionals.
1. Daniel L. Rolnik et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. DOI: 10.1056/NEJMoa1704559, New England J Med June 2017
2. Wright D et al. Aspirin for Evidence-Based Preeclampsia Prevention trial: influence of compliance on beneficial effect of aspirin in prevention of preterm preeclampsia. Am J Obstet Gynecol. 2017 Sep 6
3. Poon LC et al., ASPRE trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and
medical and obstetrical history. Am J Obstet Gynecol 2017
4. Kuklina EV, et al. Hypertensive Disorders and Severe Obstetric Morbidity in the United States. Obstet Gynecol 2009; 113:1299-306
5. COMPARE study: Performance of commercially available placental growth factor tests in women with suspected preterm pre-eclampsia, Ultrasound in Obstetric Gynecology
6. Herraiz et al Update on the Diagnosis and Prognosis of Preeclampsia with the Aid of the sFlt-1/PlGF Ratio in Singleton Pregnancies. Fetal Diagn Ther (2017) PROGNOSIS Hund et al. BMC Pregnancy and Childbirth 2014, 14:324
7. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia, Ultrasound Obstet Gynecol 2018 DOI: 10.1002/uog.20105
8. Poon L, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on Pre-eclampsia: A Pragmatic Guide for First-Trimester Screening and Prevention. International Journal of Gynegology & Obstetrics. May 2019