Pre-eclampsia Screening and Management

Pre-eclampsia is a complication of pregnancy marked by high blood pressure and presence of protein in the urine (proteinuria). 

Pre-eclampsia is 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.

The Combined Screening Program – the first step to better detection

When it comes to effectively predicting pre-eclampsia, the combined screening program outperforms screening methods that rely only on maternal history. The effectiveness of preeclampsia screening also depends on marker combination[i].

A combined screening program for pre-eclampsia is recommended by international guidelines[ii, iii] to identify women at high risk of pre-eclampsia in the early stages of pregnancy. The combined screening program consists of the PlGF 1-2-3™ blood test, maternal medical history assessment, mean arterial blood pressure measurement and, if available, uterine artery Doppler ultrasonography.

During second and third trimesters, sFlt-1 (soluble Fms-like tyrosine kinase-1) and PlGF are both predictive and diagnostic for pre-eclampsia. It has been shown that increased levels of sFlt-1 and decreased levels of PlGF in maternal serum can predict the subsequent onset of pre-eclampsia[iv, v].

Management solutions for Prenatal Screening

PerkinElmer supplies the LifeCycle™ software which enables monitoring of pre-eclampsia status with the sFlt-1/PlGF ratio. The ratio results can be linked to the same patients’ other results in LifeCycle™software. For ratio calculations, the cut-offs for pre-eclampsia management are adjustable.

First trimester prediction and prevention of pre-eclampsia

Kypros Nicolaides, Professor at King’s College Hospital, London, UK and founder of Fetal Medicine Foundation, FMF, discusses the latest advances in prediction and prevention of preterm pre-eclampsia.

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  1. O’Gorman N at al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation: comparison with NICE guidelines and
  2. ACOG recommendations. Ultrasound Obstet Gynecol. 2017 Jun;49(6):756-760
  1. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia, Ultrasound Obstet Gynecol 2018 DOI: 10.1002/uog.20105
  2. 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
  3. Lecarpentier E1, Tsatsaris V. Angiogenic balance (sFlt-1/PlGF) and preeclampsia. Ann Endocrinol (Paris). 2016 Jun;77(2):97-100.
  4. Zeisler H et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia, NEJM 374;1 January 7, 2016
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