1. Hypertension in Pregnancy NICE Guidelines
with additional diagnostic test for the PARROT trial
Mild hypertension
BP up to 149/99 mmHg
Do not admit to hospital.
Do not treat hypertension.
Measure BP no more than x1/wk
Test for proteinuria at each visit
Carry out routine antenatal blood tests.
If presenting before 32/40, or at high risk of pre-eclampsia, test for proteinuria and measure BP x2/ wk.
Moderate hypertension
BP 150/100–159/109 mmHg
Do not admit to hospital.
Treat hypertension to keep BP <150/ –100 mmHg.
Measure BP at least x2/ wk.
Test for proteinuria at each visit
Test kidney function, electrolytes, FBC, transaminases, bilirubin.
No further blood tests if no subsequent proteinuria.
Arrange fetal USS
Severe hypertension
BP ≥ 160/110 mmHg
Admit to hospital until BP ≤159/109 mmHg and treat hypertension to keep BP < 150/80–100 mmHg.
Measure BP at least x4/ day
Test for proteinuria daily
Test kidney function, electrolytes, FBC, transaminases, bilirubin at presentation & then weekly.
Arrange fetal USS
Continue care as in guidelines pathway; integrate additional information from PlGF test as shown below
PlGF >100
NORMAL
PlGF
LOW
PlGF <12
VERY LOW
CONTINUE WITH
USUAL MANAGEMENT
CONSIDER INCREASED SURVEILLANCE
ASSESS AS
PRE-ECLAMPSIA
This protocol is an example used in the NICE medical technology guidance adoption support resource for PlGF- based testing to help diagnose suspected pre-eclampsia. It was not produced for or commissioned by NICE
Algorithm version 3.0 Jan 2016 ©2016 King’s College London

2. PlGF >100 pg/ml NORMAL PlGF 12-100 pg/ml LOW PlGF <12 pg/ml
VERY LOW
Normal test result: suggestive that no placental dysfunction. Unlikely to progress to delivery within 14 days.
What does it mean?: 98% of women who are in this green range will not need delivery for pre-eclampsia within 14 days.
Median time to delivery:
< 35 weeks: 62 days
35-37 weeks: 16 days
Plan: continue with usual management.
Abnormal test result – low: suggestive of placental dysfunction. Increased risk for preterm delivery.
What does it mean? A PlGF test result <100 pg/ml will correctly identify 95-96% of women with pre-eclampsia who need delivery within 14 days.
Median time to delivery:
< 35 weeks: 23 days
35-37 weeks: 9 days
Plan: consider increased surveillance (e.g. moving one step up on the NICE chart above), with regular monitoring and fetal ultrasound if indicated.
Highly abnormal test result – very low: suggestive of severe placental dysfunction (i.e. placental ‘growth’ is very low).
What does it mean? The red range highlights those at highest risk of preterm delivery, including delivery of an SGA infant. For women presenting before 35 weeks with PlGF <12 pg/ml, 94% will be delivered preterm.
Median time to delivery:
< 35 weeks: 9 days
35-37 weeks: 4 days
Plan: consider as ‘pre-eclampsia’ (regardless of proteinuria) with admission for assessment, increased surveillance and fetal ultrasound if indicated.
Chappell et al Circulation 2013
LOW OR VERY LOW PLGF RESULT IS NOT AN INDICATION FOR DELIVERY IN ITSELF
Algorithm version 3.0 Jan 2016 ©2016 King’s College London