PIGF testing can reduce time to diagnosis of pre-eclampsia by 2 days compared with standard care, a clinical trial has found. Women with suspected pre-eclampsia who had the test were slightly less likely to experience adverse outcomes than those who did not. The cluster-randomised trial (PARROT trial) enrolled 1035 women across 11 maternity units in the UK, and found that PIGF testing in women with suspected pre-eclampsia:
Resulted in faster median time to diagnosis compared with usual care (1.9 days vs. 4.1 days, respectively; time ratio 0.36, 95% CI 0.15 to 0.87; p = 0.027)
Modestly reduced the risk of severe adverse maternal outcomes, such as eclampsia or stroke (4% vs. 5% receiving usual care, respectively; adjusted odds ratio [aOR] 0.32, 95% CI 0.11 to 0.96; p = 0.043).
No difference in the likelihood of perinatal adverse outcomes (15% vs. 14%, aOR 1.45, 95% CI 0.73 to 2.90) or gestational age at delivery (36.6 weeks vs. 36.8 weeks; mean difference –0.52, 95% CI –0.63 to +0.73) was found. Suspected pre-eclampsia was defined in the study as new or worsening hypertension, dipstick proteinuria, epigastric or right upper quadrant pain, headache with visual disturbances, fetal growth restriction, or blood test results suggestive of the condition.
PIGF is a protein involved in placental angiogenesis and prior research has shown that levels can be abnormally low in pre-eclampsia.
The UK National Institute for Health and Care Excellence advocates the use of PIGF testing to exclude a diagnosis of pre-eclampsia (within 14 days of testing) in women presenting between 20 weeks and 34 weeks plus 6 days of gestation.  NHS England has announced that the test will be made widely available across the NHS. See Diagnosis: approach ??C:topic.page.important.updates.screening_en_US?? See Diagnosis: investigations
Hypertensive syndrome that occurs in pregnant women after 20 weeks' gestation, consisting of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement.
All pregnant women presenting with hypertension and either proteinuria or evidence of systemic involvement require close assessment and monitoring for pre-eclampsia and its complications.
Delivery is the definitive treatment; the decision about when and how to deliver should only be made after a thorough assessment of the risk and benefits to the mother and baby.
Other mainstays of management include antihypertensive therapy, seizure control, and fluid restriction.
Maternal mortality is highest after delivery, so vigilance should be maintained in the postpartum period.
Can occur in subsequent pregnancies; therefore, women should be counselled about the risk.
A hypertensive syndrome that occurs in pregnant women after 20 weeks' gestation, consisting of new-onset, persistent hypertension (defined as a BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic, based on at least 2 measurements taken at least 4 hours apart) with one or more of the following: 1) proteinuria (defined as urinary excretion of ≥0.3 g/24 hours of protein); 2) evidence of systemic involvement, such as renal insufficiency (elevated creatinine), liver involvement (elevated transaminases and/or right upper quadrant pain), neurological complications, haematological complications; 3) fetal growth restriction.  
Academic Department of Obstetrics and Gynaecology
Leeds Teaching Hospitals Trust
JJW is Medical Director of Action on Pre-eclampsia (unpaid position). JJW lectures on pre-eclampsia at educational meetings (unpaid). He is a member of the International Society for the study of Hypertension in Pregnancy, and contributes towards guideline development in hypertension in pregnancy.
Clinical Research Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine
University of Leeds
LM declares that she has no competing interests.
Department of Obstetrics & Gynecology
University of Washington
TRE declares that he has no competing interests.
Professor of Obstetrics
Maternal and Fetal Research Unit
St Thomas' Hospital
King's College London
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