Lynda Verghese and Ashwin Ahuja
Betsi Cadwaladr University Health Board
Ambiguities arising out of the complexities in conventional risk stratification of women with suspected pre-eclampsia inevitably lead to repeated hospital attendances, increased use of resources, considerable anxiety for women and often missed at-risk cases.
With the advent of the COVID pandemic, in order to reduce unnecessary admissions and visits to the hospital, to optimize patient outcomes, this evidence-based pilot study was conceived.
- Accurately risk stratify the patients with suspected pre-eclampsia.
- Reduce the number of repeat outpatient attendances unnecessary hospital admissions in patients with suspected pre-eclampsia.
- Avoid missing at risk patients that may slip through the gaps.
- Preventing iatrogenic preterm births and potentially Special Care baby Unit (SCBU) admissions.
- Allay the anxiety and mental health issues for the patient and their families associated with hospitalisation.
- Optimise the use of NHS resources including but not limited to the burden on the pathology laboratories, health care staff, emergency department and maternity day assessment units – thereby making tremendous positive managerial and financial impact.
Cohort of 34 women, all 6 cases in the red group were admitted, developed severe preeclampsia (2 of which developed HELLP) within the same week, were stabilized, given prophylactic steroids in view of prematurity and were delivered. The amber group was managed with increased outpatient surveillance until a max. of 37 – 38 weeks.
- PLGF Triage testing proved to be of excellent diagnostic value in the local cohort of patients with suspected pre-eclampsia.
- Prevented maternal complications like eclampsia / stroke / DIC / death.
- Prevented foetal complications: stillbirths, prevented iatrogenic preterm deliveries
- Provided reassurance for outpatient surveillance and alleviated maternal anxiety allowing patients in this sub-group to safely go home – implications on her and her family’s mental and physical health (especially in the pandemic), associated childcare and travel costs.
- Total net bed cost savings of the outpatient management of the 68% of the cases identified in the study period saved the hospital about £ 34,304 in 6 months alone.
- SCBU cost/day saved about £1,118 day to look after iatrogenic preterm in intensive care.
- Saved medicolegal costs in terms of litigation for stillbirth/eclampsia/stroke.
- Impact on midwifery and HCA staffing and turnover in labour ward ensuring smooth transition of patient from the induction bay to the labour ward.
- Interestingly, each patient that avoids hospitalization due to the PLGF triage test reduces the greenhouse gas emissions equating to 35 T on CO2 making the project’s entire footprint to be near carbon neutral and in fact be greatly beneficial to the environment.