Publications approval reference: 001559 / C0226

To:

Maternity Clinical Leads and hospital managers
Local Maternity System representatives
Midwives
Lab managers
Finance leads

12 April 2020

Dear colleague

Placental Growth Factor (PlGF)-based testing: helping to keep women out of hospital during the COVID-19 pandemic

On behalf of the NHS Accelerated Access Collaborative national working group on PlGF-based testing, we are writing to remind you of the additional benefits of PlGF-based testing (used to help in the diagnosis of pre-eclampsia) as a means of helping to keep women out of hospital during the COVID-19 pandemic.

PlGF-based testing has a high negative predictive value (rule-out) for pre-eclampsia, meaning women who receive a negative diagnosis can be safely sent home. This is a way of safely and efficiently reducing unnecessary contact and possible spread of the coronavirus within secondary care and during hospital admission.

PlGF-based testing has been recommended for use by NICE Diagnostic Guidance (DG23) and Clinical Guidance (NG133) and is supported by the NHS Accelerated Access Collaborative and Innovation and Technology Payment (ITP) programme. PlGF-based tests have been evaluated in randomised controlled trials^** which have demonstrated a faster diagnosis of pre-eclampsia and a reduction in out-patient hospital attendances. The very high negative predictive value for ruling out preeclampsia permits extended community care with reduced monitoring or intervention.

We emphasise that this test is to be used in women with suspected pre-eclampsia. If a diagnosis of pre-eclampsia is made, women should be managed as such, independently of test results.

Two PlGF-based tests are currently recommended to assist in the diagnosis of pre-eclampsia under NICE DG23:

• Roche Diagnostics – Elecsys Sflt-1:PlGF ratio test
• Quidel Corporation – Triage PlGF Test

Updated guidance, issued by RCOG for healthcare professionals on COVID-19 infection in pregnancy, recommends that steps are taken to reduce the contact time of vulnerable pregnant women within secondary care – Guidance for maternal medicine services in the evolving coronavirus (COVID-19) pandemic.

Yours sincerely

Dr Manu Vatish MBBCh BA(Hons) DPhil MA (Cantab) MRCOG | Clinical Consultant in Obstetrics | Oxford University Hospital

Dr Jenny Myers PhD MRCOG | Consultant Obstetrician | St Mary’s Hospital, Manchester

Accelerated Access Collaborative National Working Group on PlGF-based testing, comprises:

• Accelerated Access Collaborative
• NHS England and NHS Improvement
• NICE
• Academic Health Science Network
• Roche Diagnostics
• Quidel Corporation
• PlGF Clinical Champions Dr Manu Vatish and Dr Jenny Myers

*  Predictive Value of the sFlt-1/PlGF Ratio in Women with suspected pre-eclampsia (PROGNOSIS Trial). Zeisler et al 2016 N Eng J Med 7;374 13-22
** The PARROT Study. Placental growth factor to Assess and diagnose hypeRtensive pRegnant wOmen: a
stepped wedge randomised controlled trial. Duhig et al. Published online April 1, 2019