Chair of the Preterm Preeclampsia Implementation Pilot Working Group, A/Prof Chris Lehner, provides an update on the pilot project and its potential to shape a universal screening program in Australia.
Preterm preeclampsia is a leading cause of maternal and neonatal morbidity and mortality and accounts for approximately 20% of all preterm births.
In 2024, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) published a clinical practice guideline confirming the benefit of early screening and prescribing of prophylactic low dose aspirin for women identified to be at high-risk of developing preterm preeclampsia.
As part of the funding agreement with the Commonwealth, the Australian Preterm Birth Prevention Alliance (the Alliance), in partnership with Women’s Healthcare Australasia (WHA) and the Institute for Healthcare Improvement (IHI), has been tasked with co-designing and testing an implementation plan for preterm preeclampsia screening in early pregnancy across various maternity care settings in Australia.
The aim of this pilot is to identify the enablers and barriers to universal preterm preeclampsia screening across all care settings – from rural and remote communities, primary healthcare facilities to metropolitan tertiary maternity services.
During the annual congress of the Perinatal Society of Australia and New Zealand in March 2025, the Alliance formed an expert working group and invited key stakeholders to collaborate on designing a roadmap for implementation of universal preterm preeclampsia screening in all jurisdictions.
It was decided to adopt the Fetal Medicine Foundation (FMF) screening tool, which is offered both online or as a software application. This validated, first-trimester screening protocol combines maternal risk factors with biophysical and biochemical markers to generate a pregnant person’s individual risk of developing preterm preeclampsia.
The test is offered between 11-14 weeks gestation to identify women at high-risk of developing the disease early in pregnancy. This allows for timely intervention, particularly prescription of low dose aspirin, which has been shown to significantly reduce the incidence of preterm preeclampsia if commenced prior to 16 weeks’ gestation.
The working group sought expression of interests to participate in a pilot program focused on early screening and prevention of preterm preeclampsia. A total of nine maternity services have subsequently been invited to participate in the program.
Confirmed Sites
Preterm Preeclampsia Screening Pilot
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Participating Site/Service
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State/Territory
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Busselton
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Western Australia
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Wadeye
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Northern Territory
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The Royal Women's Hospital Melbourne
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Victoria
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Northern Health
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Victoria
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Illawarra Shoalhaven LHD
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New South Wales
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Central Coast LHD
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New South Wales
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Centenary Hospital for Women and Children
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Australian Capital Territory
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North West HHS
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Queensland
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Palm Island Community Company
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Queensland
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The goal of this pilot work is to understand current practice across Australia, learn from sites which have been successful in offering universal preterm preeclampsia screening in their service and share problems encountered during this process.
The pilot program will elaborate and propose solutions to these problems and inform a report to the Commonwealth outlining enablers, barriers and recommendations to support national roll out of universal screening in Australia.
Support of our work has been overwhelmingly positive. A well-established existing network of clinical leadership through APTBPA in each jurisdiction and Improvement Advisors through WHA and IHI is already in place.
We have already seen encouraging positive examples of successful implementation of screening – even in disadvantaged and under-resourced settings – which we can draw upon and learn from as we progress this work.
But there needs to be more collaborative work done to overcome obvious barriers to offering universal preterm preeclampsia screening on a national scale. Many services are experiencing staffing and resourcing challenges. It is imperative that consistent and sustainable education and training needs to be provided to ensure high quality standards (e.g. uterine artery Doppler measurements on ultrasound).
The lack of sufficient public funding on integral components of the proposed FMF screening algorithm (eg Placental Growth Factor – PLGF), which currently results in inequitable service provision, is another challenge. In this scenario, the screening tool needs to be adjusted to have indigeneity as maternal characteristic included so that it can be used in the Australian context.
After completion of this program in June 2026, we hope to understand current enablers to offer screening whilst elaborating solutions to overcome barriers to universal implementation of this screening program.
We will remain focussed on our goal of achieving a sustainable reduction of preterm preeclampsia and its harmful consequences of maternal and perinatal morbidity and mortality including preterm birth.
A/Prof Chris Lehner
Clinical Excellence Queensland
Chair, Preterm Preeclampsia Screening Working Group
