Placental growth factor testing for suspected preeclampsia

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Preeclampsia can lead to serious complications yet it is often asymptomatic and can be difficult to diagnose. Testing circulating concentrations of placental growth factor (PIGF) may have value as a diagnostic adjunct in women with suspected preeclampsia, according to results of research by British investigators. 

Published in The Lancet, the findings are from a randomized controlled trial conducted in 11 maternity units in the UK that enrolled women aged 18 and older with suspected preeclampsia between 20 weeks 0 days and 36 weeks 6 days gestation. All 1019 received usual care and were tested for PIGF, but in 446 cases, results of the testing were revealed to their clinicians whereas in 573 cases, the results were concealed. 

The primary outcome of the trial was the time from presentation with suspected preeclampsia to documented preeclampsia in women who received a diagnosis of preeclampsia by their treating clinicians. The purpose of the study was to determine whether integration of the PIGF results into the clinical algorithm lowered the time to diagnosis in cases of suspected preeclampsia and ultimately reduced subsequent maternal or perinatal adverse outcomes. PIGF has been shown to have high sensitivity and a negative predictive for determining need to deliver in women with suspected preeclampsia but this is the first clinical trial in which it has been assessed. 

With concealed PIGF testing results, median time to preeclampsia diagnosis was 4.1 days versus 1.9 days with revealed testing results (P= 0.027). Maternal severe adverse outcomes were reported in 24 (5%) of the women in the concealed group versus 22 (4%) of the women in the revealed testing group. (P= 0.043). There was no evidence, however, of a difference in perinatal adverse outcomes or gestation at delivery (36.6 weeks vs 36.8 weeks).

The authors said their trial showed that, “with implementation of PIGF-based testing, clinicians make a quicker diagnosis of preeclampsia and there is an associated reduction in serious maternal adverse events.” They said their trial evaluated “real-world” effectiveness of PIGF and noted that revealing PIGF results did not change clinical indications for elective early delivery in the participants or make a difference in gestational age at delivery.