New guidance has been published by the National Institute for Health and Care Excellence (NICE) recommending the use of placental growth factor (PLGF) based testing to help diagnose pre-eclampsia in pregnancy. PLGF is a protein which helps the development of new blood vessels in the placenta. PLGF tests measure the level of this protein in the blood. PLGF levels can be low in pregnant women who have pre-eclampsia. PLGF testing was previously only recommended to rule out pre-eclampsia. However, following consideration of additional evidence and research, NICE has now approved four PLGF-based tests which can reliably help maternity healthcare providers diagnose (or ‘rule in’) pre-eclampsia. NICE’s new guidance recommends that PLGF testing should now be used alongside standard clinical assessment of the mother’s condition where pre-eclampsia is suspected between 20 weeks and 37 weeks of pregnancy. This should provide additional certainty and support vital decisions about early monitoring, treatment and the timing of the birth to reduce the risk of serious harm to mothers and babies from this potentially dangerous condition. Following the publication of the new guidance, NICE now intends to develop tools to help healthcare organisations put the guidance into practice. What is pre-eclampsia? Pre-eclampsia is a common but potentially serious complication which can develop in the later stages of pregnancy. In the UK, mild pre-eclampsia affects up to 6% of pregnancies with severe pre-eclampsia developing in up to 2% of cases. The cause of pre-eclampsia is unknown but may be related to problems with the development of the placenta. Expectant mothers who have mild pre-eclampsia may only become aware of the condition when it is picked up during routine antenatal checks of the mother’s blood pressure and urine. Current guidance for the antenatal care of pregnant women includes a requirement for these checks to be carried out at each antenatal appointment. If their blood pressure first becomes abnormally high (hypertension) after 20 weeks of pregnancy and/or there is evidence that protein has leaked from their kidneys into their urine (proteinuria) they should be seen by a specialist and may need hospital admission, monitoring and treatment for pre-eclampsia. Current guidance also says that the mother’s individual risk factors for pre-eclampsia should be assessed at the booking appointment which usually takes place by the tenth week of pregnancy. What are the signs and symptoms of pre-eclampsia? The classic signs of pre-eclampsia are raised blood pressure (hypertension) which develops in pregnancy and proteinuria. Other symptoms of pre-eclampsia include: severe headaches; sudden swelling (oedema) of the face, hands, ankles or feet; problems with vision, such as blurring or flashes; vomiting (being sick); pain below the ribs; low urine output. The NHS advises anyone who is pregnant and is experiencing symptoms of pre-eclampsia, to seek medical advice immediately by calling their midwife, GP surgery or NHS 111. What are the dangers of pre-eclampsia? The risk of pre-eclampsia should be considered throughout the pregnant mother’s maternity care, as mothers and unborn babies who are affected by pre-eclampsia require specialist care and careful monitoring. Failure to recognise signs of pre-eclampsia or to monitor the pregnant mother and her baby once the condition has been diagnosed can lead to life-threatening complications. These include: eclampsia – seizures or fits and risk of brain injury from lack of oxygen (asphyxia) to mother and/or baby; HELLP syndrome – a rare liver and blood clotting disorder; disseminated intravascular coagulation (DIC) – a blood clotting disorder which affects the blood supply causing damage to organs; stroke – caused by disruption of the blood supply to the brain; organ failure or dysfunction, such as pulmonary oedema (affecting the lungs), liver failure, kidney failure; placental abruption – early detachment of the placenta; problems with the baby’s growth - intrauterine growth restriction (IUGR); problems arising from premature birth, such as respiratory distress syndrome from under-developed lungs, blindness from retinopathy of prematurity; stillbirth; maternal death. Can pre-eclampsia be treated? Pre-eclampsia must be treated with careful monitoring of the mother and baby’s health. This is often best achieved by admitting the mother to hospital. There is no cure for pre-eclampsia, so the mother and baby’s condition are monitored and managed until it is safe to deliver the baby. Treatment of pre-eclampsia can include: admission to hospital; blood pressure checks;; urine tests, to check for proteinuria; blood tests, to check the liver, kidneys etc; medication to help lower blood pressure to safe levels; medication to prevent or reduce fits or seizures (in very severe cases); ultrasound scans of the unborn baby to check their growth, amniotic fluid and blood supply; fetal heart-rate monitoring by CTG to check for signs of fetal distress; early delivery of the baby. Who is at risk of pre-eclampsia? Pre-eclampsia is a common complication of pregnancy, and anyone can be affected. However, the risk of developing pre-eclampsia is known to be higher where the mother has: diabetes; high blood pressure (which began before the pregnancy); kidney disease (which began before the pregnancy); lupus or other autoimmune conditions; a history of high blood pressure or pre-eclampsia in a previous pregnancy. The risk of developing pre-eclampsia in pregnancy is also higher for people: with a family history of pre-eclampsia; aged 40 years of age or older; with a gap of 10 years or more since their last pregnancy; expecting multiple babies (twins or triplets); whose BMI (body mass index) is 35 or more. Understanding and monitoring the risks of pre-eclampsia during pregnancy is essential for the safety of mothers and their babies. Severe and permanent injury can be caused by delays and failings in care. Boyes Turner’s birth injury team welcome the new NICE guidance opening the way for earlier and more accurate diagnosis of pre-eclampsia in the hope that it will give more mothers and babies a happier and safer experience of pregnancy as a result of better informed, specialist care. If you or your child has been severely injured as a result of medical negligence and you would like to find out more about making a claim, you can talk to one of our experienced solicitors, free and confidentially, by contacting us here.
