Last reviewed:September 2019
Last updated:April  2019
25 Apr 2019

Placental growth factor (PIGF) test aids earlier preeclampsia diagnosis

PIGF testing can reduce time to diagnosis of preeclampsia by 2 days compared with standard care, a clinical trial has found. Women with suspected preeclampsia who had the test were slightly less likely to experience adverse outcomes than those who did not. The cluster-randomized trial (PARROT trial) enrolled 1035 women across 11 maternity units in the UK, and found that PIGF testing in women with suspected preeclampsia: 

  • 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 preeclampsia 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 preeclampsia.

See Diagnosis: approach?? Diagnosis: investigations

Original source of update



History and exam

Key diagnostic factors

  • >20 weeks' gestation
  • BP ≥140 mmHg systolic and/or ≥90 mmHg diastolic and previously normotensive
  • headache
  • upper abdominal pain

Other diagnostic factors

  • reduced fetal movement
  • fetal growth restriction
  • edema
  • visual disturbances
  • seizures
  • breathlessness
  • oliguria
  • hyper-reflexia and/or clonus

Risk factors

  • primiparity
  • preeclampsia in previous pregnancy
  • family history of preeclampsia
  • BMI >30
  • maternal age >35 years
  • multiple (twin) pregnancy
  • subfertility
  • gestational hypertension
  • pregestational diabetes
  • polycystic ovary syndrome (PCOS)
  • autoimmune disease
  • renal disease
  • chronic hypertension
  • BP ≥80 mmHg diastolic at booking
  • interval of 10 years or more since previous pregnancy
  • high-altitude residence

Diagnostic investigations

1st investigations to order

  • urinalysis
  • fetal ultrasound
  • fetal cardiotocography
  • fetal biometry
  • umbilical artery Doppler velocimetry
  • amniotic fluid assessment
  • CBC
  • liver function tests
  • serum creatinine
  • placental growth factor
Full details

Treatment algorithm


James J. Walker


Academic Department of Obstetrics and Gynaecology

Leeds Teaching Hospitals Trust




JJW is Medical Director of Action on Pre-eclampsia (unpaid position). JJW lectures on preeclampsia 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.

Peer reviewersVIEW ALL


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




Not disclosed.

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