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Early detection of pre-eclampsia is crucial, but diagnosis can be challenging: clinical presentation can be variable and the disease often progresses over several weeks before a diagnosis is confirmed.1 Improved understanding of pre-eclampsia has led to the development of new placental growth factor (PlGF)-based tests that can help to identify women at high risk of developing the disease, and to ‘rule out’ in the short-term those who are not.2-5

After studying this module you should:

  • Recognise the challenges associated with diagnosing pre-eclampsia.
  • Understand the role of angiogenic factors in the pathogenesis of pre-eclampsia.
  • Appreciate how PlGF-based tests can aid clinical decision making for women with suspected pre-eclampsia.

  • Read the clinical review: if you don't have a printed version, click here to download a pdf
  • Complete the online assessment
  • Receive CPD certificate

Written by: Tara Ralph BSc (Hons)
Reviewed by: Nicky Clark RM, RGN, ADM, Cert Ed (Adults), MA

This module was created in association with
Roche Diagnostics Limited

Please log in or register to take this module

The content of this website is subject to editorial review however you should seek independent validation where required.    Content on the website is correct at the time of publishing, and will be reviewed every 2 years aligned to medical best practice

Pre-learning reflection

Please take a moment to answer these pre-learning questions.  Once completed, click 'next step' below to start this module.  These answers will be logged on your CPD certificate which will be emailed to you on completion as evidence of your learning.

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Pre-eclampsia carries significant risks for mum and baby

Pre-eclampsia affects between 2 and 5% of pregnancies in the UK.6-8 It is traditionally diagnosed when a woman presents with new-onset hypertension and proteinuria after 20 weeks of pregnancy or soon after the birth of the baby.2,9

Left unchecked, pre-eclampsia can progress to:

  • eclampsia (onset of seizures)
  • HELLP syndrome (haemolysis, elevated liver enzymes and low platelets)
  • disseminated intravascular coagulation
  • stroke
  • organ dysfunction.2

Women with pre-eclampsia require close monitoring in hospital, whereas women with chronic or gestational hypertension can be managed as outpatients, unless their blood pressure reaches or exceeds 160/110 mmHg.2

  • Pre-eclampsia can also place the fetus at greater risk of:
  • intrauterine growth restriction
  • prematurity
  • intrauterine death.9

Table 1 provides definitions of the key terms used in this module.

Table 1: Key definitions used in this module

Already studied the clinical review? Go straight to the test here
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Diagnostic criteria for pre-eclampsia were updated in 2014

The International Society for the Study of Hypertension in Pregnancy (ISSHP) changed the diagnostic criteria for pre-eclampsia in 2014.9

The revised definition is: de novo hypertension developing after 20 weeks’ gestation and the coexistence of one or more of the following new onset conditions:

  • proteinuria
  • other maternal organ dysfunction, e.g. renal insufficiency, liver involvement, neurological or haematological complications
  • fetal growth restriction.9
Diagnosis of pre-eclampsia is currently based on antenatal assessment of risk factors (see Table 2), routine monitoring of blood pressure and urine, and blood tests to monitor kidney and liver function, and platelets.2,10

Table 2: Risk factors for the development of pre-eclampsia2

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Diagnosis can be challenging

Pre-eclampsia is one of four hypertensive disorders of pregnancy (see Table 3).10,11 It can be unpredictable and clinical presentation is variable,1 often progressing over several weeks before diagnosis.

The presence of other pre-existing conditions can further complicate diagnosis.

As pre-eclampsia is defined as new-onset hypertension, it is important to document the woman’s blood pressure early in pregnancy as a baseline, before the pregnancy-related dip in blood pressure during the second trimester.9

Because hypertension and proteinuria can be poor predictors of disease onset and progression, a high proportion of women with signs and symptoms of pre-eclampsia may be hospitalised for observation unnecessarily.

Table 3: Hypertensive disorders of pregnancy6,11

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Pre-eclampsia begins in the placenta

The causes of pre-eclampsia are not completely understood, but the disorder is thought to start in the placenta.

In a normal pregnancy, the maternal uterine vessels supplying the placenta (spiral arteries) begin to change at about 10 weeks’
gestation.12 They dilate and lose their smooth muscle to become flaccid, large diameter vessels capable of transmitting increased volumes of blood to the placenta.12,13

In pre-eclampsia, the spiral arteries do not remodel. Instead, they remain narrow and highly resistant, and are unable to supply sufficient blood to the placenta.12,13

This is shown in Figure 1.

Figure 1: Abnormal blood vessel development in pre-eclampsia

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In pre-eclampsia, levels of sFlt-1 are elevated

To compensate for the reduced blood flow through the spiral arteries, the placenta releases substances into the maternal bloodstream to increase blood vessel permeability, blood pressure and the blood’s tendency to clot.14

These substances include antiangiogenic factors, such as soluble fms-like tyrosine kinase-1 (sFlt-1),4,12 which cause vasoconstriction and endothelial damage throughout the body.4

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Levels of placental growth factor are lower in women with pre-eclampsia

Placental growth factor (PlGF) is released by the placenta and has proangiogenic effects on the fetal and placental circulation.15 In a normal pregnancy, PIGF levels increase during the first two trimesters and then decline until delivery.4

Levels of PlGF are found to be lower in women with pre-eclampsia.  This may be due to:

  • decreased release of PlGF as a consequence of poor placental perfusion
  • reduced free PlGF in the presence of increased sFlt-1, since sFlt-1 ‘disables’ PlGF by binding to it.15

A high ratio of sFlt-1 to PlGF is associated with an increased risk of pre-eclampsia. This ratio may be a better predictor of risk than either PlGF or sFLT-1 on their own.4

Importantly, the increased levels of sFlt-1 and decreased levels of PlGF seen in women with pre-eclampsia are not only evident at diagnosis, but also weeks in advance of its onset.4,15

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Early- and late-onset pre-eclampsia develop differently

Pre-eclampsia can be divided into early-onset (<34 weeks) and late-onset (>34 weeks). Each has a different pathophysiology.5

Early-onset or placental pre-eclampsia

  • Thought to be caused by abnormal remodelling of the spiral arteries and insufficient blood supply to the placenta.
  • Associated with fetal growth restriction or small-forgestational-age babies, and confers a significantly higher chance of adverse outcomes for mother and baby.16,17

Late-onset or maternal pre-eclampsia

  • Little evidence of abnormal artery remodelling, instead it appears to be a mismatch between maternal supply and the demands of the growing fetus close to term.10,16,18
  • In most cases of late-onset pre-eclampsia, babies are a normal size or large for gestational age.16

Altered levels of sFlt-1 and PlGF are seen in both early- and late-onset pre-eclampsia, although it is less pronounced in late-onset
compared to early-onset pre-eclampsia.16

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Blood tests that measure placental growth factor can aid diagnosis

Simple PlGF-based blood tests are now being used in a few NHS organisations to aid diagnosis of suspected preeclampsia.19

The latest NICE guidance recommends the use of PlGF-based blood tests to help rule-out pre-eclampsia in women between 20 weeks and 34 weeks plus 6 days’ gestation.2

NICE recommends two PlGF-based tests:

  • The Triage® PlGF test, which measures PlGF levels in a maternal blood plasma sample.2
  • The Elecsys® immunoassay sFlt-1/PlGF ratio, which measures the amount of sFlt-1 relative to PlGF in maternal serum samples.2
Both the above mentioned tests are also supported by the Accelerated Access Collaborative* (AAC).19

* The AAC is a unique partnership between representatives of healthcare organisations – including NHS England, NICE and the Department of Health and Social Care – and the health technology industry. The purpose of the AAC is to get ‘breakthrough’ technologies to NHS patients more quickly.

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NICE recommends PIGF-based tests to rule-out pre-eclampsia

The NICE guidance states that PlGF-based tests should only be used to rule-out pre-eclampsia in the short term. If the test result does not rule out pre-eclampsia, the result should not be used to diagnose pre-eclampsia.

NICE recommends further research before these tests can be used to routinely diagnose pre-eclampsia within the NHS.2

The use of these tests – in conjunction with blood pressure monitoring, urine analysis, haematological tests and clinical judgment – could result in faster and more accurate diagnosis of pre-eclampsia and better risk assessment for adverse outcomes in women with suspected pre-eclampsia.2

PlGF-based tests also allow women in whom pre-eclampsia has been ruled out to return home instead of being admitted to hospital for monitoring, reducing stress for the woman and freeing up hospital beds.2

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PIGF-based tests offer many advantages

NHS staff who have used PlGF-based testing, cite the following benefits:20

  • Supports decision making on appropriate patient pathway.
  • Provides reassurance to clinicians and pregnant women who are sent home that they do not have pre-eclampsia at that point.
  • Reduces hospital admissions solely for monitoring.
  • Helps to identify appropriate surveillance frequency when pre-eclampsia is ruled out.
For further training in pre-eclampsia, visit the APEC (Action on Pre-eclampsia) website:

Previous step
Now that you have reviewed the learning, please complete the following multiple choice questions to test what you've learnt and receive your CPD certificate.

Assessment – Definition of pre-eclampsia

Which of the following is the ISSHP’s (The International Society for the Study of Hypertension in Pregnancy) revised definition of pre-eclampsia?
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Assessment – Risk factors

Which of the following are high-risk factors for pre-eclampsia? (Select all that apply)
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Assessment – Angiogenic factors

Which of the following statements best describes typical levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) in a woman with pre-eclampsia?
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Assessment – Early- and late-onset pre-eclampsia

Which of the following statements are FALSE? (Select all that apply)
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Assessment – PlGF-based blood tests

Which of the following statements are TRUE? (Select all that apply) According to the latest NICE guidance, PlGF-based blood tests should be used:
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Post-learning reflection

Please take a moment to answer these post-learning questions.  These answers will be logged alongside your pre-learning responses on your CPD certificate which will be emailed to you on completion as evidence of your learning.

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References and further reading

1. Duhig KE, Shennan AH. Recent advances in the diagnosis and management of pre-eclampsia. F1000Prime Reports. Published online 2015. DOI: 10.12703/P7-24.

2. National Institute for Health and Care Excellence (2016) PlGF-based testing to help diagnose suspected pre-eclampsia (Triage PlGF test, Elecsys immunoassay sFLT-1/PIGF ratio, DELFIA Xpress PlGF 1-2-3 test, and BRAHMS sFLT-1 Kryptor/BRAHMS PlGF plus Kryptor PE ratio). NICE Diagnostics guidance.

3. Zeisler H et al. Predictive value of the s-FLT:PlGF ratio in women with suspected pre-eclampsia. NEJM 2016, 374 (1):13-22.

4. Rana S et al. Angiogenic factors and the risk of adverse outcomes in women with suspected pre-eclampsia. Circulation. Published online 2011. DOI: 10.1161/CIRCULATIONHA.111.054361

5. Armaly Z et al. Preeclampsia: novel mechanisms and potential therapeutic approaches. Frontiers in Physiology. Published online 2018. DOI: 10.3389/fphys.2018.00973.

6. Hendy E et al. Incidence of pre-eclampsia in the UK in 2016-17. Pregnancy Hypertension, 2017, 9: 25.

7. Mol BWJ et al. Pre-eclampsia. The Lancet 2016, 387: 999-1011.

8. NHS.UK. Pre-eclampsia. 2018. Available at: September 2018.

9. Tranquili AL et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertension 2014, 4: 97-104.

10. National Institute for Health and Care Excellence (2010) Hypertension in pregnancy: diagnosis and management. Clinical guideline.

11. Mammaro A et al. Hypertensive disorders in pregnancy. Journal of Prenatal Medicine 2009; 3(1): 1-5.

12. Chaiworapongsa T et al. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol 2014; 10(8):466-480.

13. Roberts JM, Escudero C. The placenta in preeclampsia. Pregnancy Hypertens 2012; 2(2): 72-83.

14. Uzan J et al. Pre-eclampsia: pathophysiology, diagnosis and management. Vascular Health and Risk Management 2011; 7: 467-474.

15. Chau K et al. Placental growth factor and pre-eclampsia. Journal of Human Hypertension 2017; 31: 782-786.

16. Erez O, Romero R, Maymon E et al. The prediction of late-onset preeclampsia: results from a longitudinal proteomics study. PLoS ONE 2017; 12(7): e0181468

17. English FA et al. Risk factors and effective management of preeclampsia. Integrated Blood Pressure Control 2015; 8: 7-12.

18. Sohlberg S et al. Placental perfusion in normal pregnancy and early and late preeclampsia: a magnetic resonance imaging study. Placenta 2014; 35: 202-206.

19. National Institute for Health and Care Excellence (2018) Accelerated Access Collaborative. Available at: Accessed October 2018.

20. National Institute for Health and Care Excellence (2016) Adoption Support Resource - Insights from the NHS.

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Medicare Resources

Administration on Aging
For help in finding local, state and community-based organizations that serve older adults and their caregivers in your area, call Eldercare at 1-800-677-1116, TTY 711, 8 a.m. to 8 p.m. Eastern Standard Time, Monday through Friday, or visit Eldercare.gov.

Hospice Information
For information about hospice care programs in your area, call your state’s hospice care organization. Call the Medicare Helpline at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, seven days a week, to get the number in your state. Or visit HospiceDirectory.org.

Medicare & You
The official Medicare handbook for Medicare programs is updated each year. You can download a copy at Medicare.gov or call the Medicare Helpline to request a copy. Medicare’s online tools can also help you compare drug plans Medicare Advantage (Part C) plans and Medicare supplement insurance (Medigap) plans.
Medicare Helpline

For questions about Medicare and detailed information about plans in your area call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, seven days a week. Or visit Medicare.gov

National Council on Aging
The National Council on Aging (NCOA) is a nonprofit service and advocacy organization dedicated to helping seniors find jobs and benefits, improve their health, live independently, and remain active in their communities. Go to NCOA.org to learn more.

Social Security Administration
For help with questions about eligibility, enrollment and arranging for help with the cost of Medicare, and for answers about Social Security retirement and disability benefits, go to SSA.gov or call 1-800-772-1213, TTY 1-800-325-0778, 7 a.m. to 7 p.m. local time, Monday through Friday.

Considerations for Older Travelers
As an increasing number of older U.S. citizens are traveling abroad, the U.S. Department of State wants you to be prepared so you can enjoy your trip. Please consider the information when planning your trip. Go to travel.state.gov to learn more.

Making the Move to Assisted Living
If you’re having more and more difficulty with everyday activities such as showering, dressing, getting around the house, and running errands, an assisted living facility may be the answer. You can get the daily support you need while remaining as independent as possible. Go to Help Guide.org

Moving Tips for Seniors
Moving is a big job, but when you're a senior and you're moving from the home you've raised your family in to something smaller, you have some specific considerations you have to make. Visit Your Storage Finder

Retirement Business Ideas for Seniors
If you are retired, it is time to start enjoying life. You have put in your time and energy to build up your savings and retirement funds so you can travel, explore your passions, and partake in the simpler pleasures life has to offer. Visit Commercial Capital Training

A Place for Mom - Veteran Aid
A Place for Mom and VeteranAid.org hosted a webinar about Veterans Aid & Attendance pension benefits. Learn more about the important financial benefits for veterans and surviving spouses. Visit A Place for Mom

Veteran Aid.Org
The Veterans Aid and Attendance (A&A) Pension provides benefits that reduce the cost of care for veterans and surviving spouses who require assisted living. Visit VeteransAid.org

Additional Resources

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Posts Tagged ‘Water’

Prescription 2016: Natural Appetite Suppressants

May 30, 2016 Written by JP

Appetite suppressants have earned a well deserved, bad reputation in many medical circles. Time after time, so called miracle “diet pills” have failed to promote sustained weight loss and/or caused serious side effects. Perhaps the highest profile example is fen-phen, a drug combination consisting of fenfluramine and phentermine. In 1997, the FDA required that fen-phen be pulled from the US marketplace after numerous reports of heart valve disease and pulmonary hypertension became too common to ignore.

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Posted in Alternative Therapies, Diet and Weight Loss, Food and Drink | 26 Comments & Updates

Mineral Water Question

August 17, 2012 Written by JP

I was recently contacted by a young lady whose mother has osteoporosis. I was told that she’s unable to have dairy and many calcium-fortified foods such as orange juice and soy products. In addition, she has a difficult time swallowing pills. On the other hand, she very much enjoys mineral water. Her question to me was, “Can I drink mineral water instead of taking a calcium supplement?”.

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Posted in Bone and Joint Health, Food and Drink, Nutrition | 10 Comments & Updates

Hydrotherapy for Multiple Sclerosis

August 31, 2011 Written by JP

Recently, news of a major discovery in the field of multiple sclerosis (MS) research was presented in the journal Nature. An examination of 9,772 patients with MS and 17,376 “healthy” volunteers confirmed that 57 genes were associated with the disease. This finding should help MS specialists move closer to pinpointing a cause and eventually a cure. But, in the here and now those already living with MS need to be aware of safe treatments that are currently available.

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Posted in Alternative Therapies, Exercise, Mental Health | 26 Comments & Updates

Meridia Drug Removal

October 11, 2010 Written by JP

One of the top news stories from this past week was the “voluntary” removal of the weight loss drug Meridia from the US market. Dr. John Jenkins, the director of the Food and Drug Administration’s drug evaluation branch, stated “Meridia’s continued availability is not justified when you compare the very modest weight loss that people achieve on this drug to their risk of heart attack or stroke”. Presently, there are an estimated 100,000 patients in the US using this previously sanctioned medication. But now, they’re being urged to discontinue using it and consult with their physicians about alternative means of losing those extra pounds. My Healthy Monday tip of the week is to strategically use safe dietary techniques to accomplish your weight loss goals instead of potentially dangerous drugs.
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Posted in Diet and Weight Loss, Nutrition | 4 Comments & Updates

Healthy Humility

August 26, 2010 Written by JP

This past year I’ve devoted a considerable amount of time establishing a presence on Twitter – the premiere social networking website on the Internet. I find that it’s a good way to stay in touch with like-minded people and it also allows me to supplement the more in depth columns I post here with a form of mini or micro blogging. All told, I’m able to reach a wider audience in a format that suits the time constraints that are common in modern life. Another benefit of immersing myself in Twitter is that I’ve learned a great deal from the messages or tweets posted by numerous health experts and non-professionals alike. Here are some of the latest examples that I found interesting.
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Posted in Diet and Weight Loss, Exercise | 2 Comments & Updates

Water Weight Loss

August 17, 2009 Written by JP

If you’re trying to lose weight, drink more water. That’s what many dieters believe. But is that assertion accurate or just a myth? Several recently published studies help to clarify this issue. As is often the case, there isn’t a simple yes or no answer to this question. But looking at the research carefully can help us figure out how to use water to its greatest advantage. Read more »

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Posted in Nutrition | 13 Comments & Updates


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Healthy Living

6 Easy Ways to Regain the Weight You've Lost

By Sheryl Kraft

Created: 10/25/2011
Last Updated: 01/30/2018

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Congratulations! You've worked hard to take off that 10, 20 or more pounds that snuck up on you seemingly overnight. Maybe you've taken up exercise, sworn off the carbs, switched out full-fat ice cream for frozen yogurt or taped your mouth shut. Whatever it was, you worked hard and you should be proud of yourself.

And now … the hard work begins. What's that? Keeping the weight from ever crossing your path again. A dismal failure rate of 99 percent has been associated with that challenge. Truth is, many people focus more on the actual diet than with keeping the weight off for good. And when you consider the interplay of physiology and behavior, weight maintenance can be a tricky proposal.

If you're the type of person that likes to be in the majority, I've done you a favor. Even though new data from the National Weight Control Registry (NWCR) shows that there are people who have managed to lose at least 30 pounds and keep it off for a year or longer, here is how you can stay in the majority that hasn't managed that feat:

  1. Don't track your food intake. Why be accountable for what you're eating? It's easier to play a game of denial, I-don't-remember, out-of-sight-out-of-mind. After all, if you've eaten it and written it down, you actually have to be reminded that you quaffed three slices of blueberry pie or two heaping scoops of rocky road.
  2. Skip breakfast. You don't need the most important meal of the day. Why eat in the morning when it takes all your effort to gulp down some coffee and run out the door? You have way more important things to do than that. And on the importance scale, eating a meal that is shown to reduce your risk of diabetes and obesity is way low.
  3. Watch a LOT of television. Make sure to stay put during the commercials (instead of getting up to stretch or sneak in some quick exercise), which are a great reminder of things you haven't thought about eating but are now suddenly craving—those calorie-dense, low-nutrient foods that have taken up residence in your immediate-gratification wish list. Don't pay attention to the research that shows that adults consume more of both healthy and unhealthy snack foods following exposure to snack food advertising, whether or not they're even hungry. And while you're at it, grab a bag of crunchy, fatty snacks like chips or cookies to keep you company throughout your date with your couch.
  4. Eat out. Why cook for yourself and control what you eat and how it's cooked when you can sit, relax and let someone else decide how much and what kinds of creamy, calorie-dense concoctions you'll consume? And while you're at it, hit some fast-food places—an added plus, since your budget won't take as big a hit!
  5. Don't combine diet with exercise. It could make it easier to not only lose weight, but also maintain that loss. Who needs to spend time exercising when instead you can hit the snooze button and sneak in an extra 10 minutes of sleep instead of taking a quick 10-minute walk? You'll only forfeit 100 calories. And chances are that during the day, you wouldn't want to take a 10-minute break to do something as simple as walking up and down a flight of stairs. After all, why burn 100 calories if instead you can spend that time sitting with your feet up, catching up on the latest on Demi and Ashton—or better yet, multitasking by reading a magazine and munching on a bag of your favorite chips.
  6. Don't weigh yourself regularly. Why get the bad news from a bunch of trivial numbers? Put the scale away. It's so much more fun to make a guessing game out of it. You wouldn't want to be in the 75 percent group of successful losers from the NWCR who weigh themselves at least once a week (or those who—gasp!—hit the scale daily) and have a built-in voice that warns, "Hey, you! Time to cut back on the calories." Who needs that obnoxious warning every time you see some digits?

Some extra reading for you (good to do while you're pedaling on a stationary bike!):
5 Sneaky Eating Tips to Help You Lose Weight
How to Lose Weight When Nothing Seems to Work

Ugh. I am always yo-yoing. It's just so hard. Those are great reminders, but for me it just gets to the point of being tired of depriving myself.

Sorry about that perennial yo-yo, NoPot. IWhy not try thinking of it as a change in the way you eat rather than deprivation? A shift in thinking can be tough, but not impossible.

Thanks for the reminder Sheryl. You are so right. Always easy to lose the weight, but keeping it off is entirely another kind of problem, which, unfortunately I always forget about. That is until I finally get back on the scale. OUCH!

Yes. Judy, that scale speaks the truth (unless it's broken or needs new batteries :)

Ugh. I need to drop the 20 pounds FIRST, then make sure that I'm not breaking these rules.

Good luck with those 20 pounds. You can do it, Kris! Slow and steady...

Great set of tips. So many people think it's losing the weight that takes all the work. But keeping it off is equally or maybe more difficult. But it all comes down to calories in and calories out. Staying active and watching what you eat in terms of portion size and fatty/high caloric toppings, spreads and dressings.

You are so right, Jeanine. Sounds like you fully understand the process!

Good tips. I never have a problem not skipping breakfast but sometimes I skip lunch or eat it so late that I'm just ravenous then I eat too much or snack, snack, snack until dinner. I'm trying to be better about that.

Oh, I know that feeling well. Waiting until you are starving to eat can surely backfire. But sometimes we get so busy, there is simply no choice. Guilty of the same, at times.

I am going through this now! In some ways it's harder to maintain weight loss than lose it. The tips from the National Weight Loss Registry are really helpful.

Sorry you are dealing with this, Nancy...but glad you found some of the tips helpful. Good luck!

Thanks for these tips. I have discovered that it's harder to lose weight at 65 than 55. (It was also harder at 55 than 45.) Keeping the weight off in the first place must be the answer.

I hear you, Alexandra. Each decade seems touring it's own set of challenges, especially where weight managementis concned. If you can keep one step ahead of weight gain, so much the better!

I had to read the header twice to realize what was going on! I think you've taken a topic and made it interesting for readers, and hopefully it will help and inspire many!

Thanks, Merr. Glad you took the time to read it!

I like this reverse psychology. I'm inspired NOT to do these things (thank goodness we have NO TV in our house. But sitting too long at the computer is JUST AS BAD)!

Pleased you like it, Jennifer. Having no tv in the house is something that intrigues me. I'd like to try that, if only as an experiment to see how this very-little-tv-watcher would be affected (or not).

I just wish I could get to a good weight and have to worry about these steps!

I know, LL That is a difficult challenge, too. Good luck!

Eat protein, lower the carbs, I have lost alot of weight from doing that.. it really works!

Ok, I had to click through and read this because all I could think was, what? Why would I want to regain the weight that took me so long to lose? Of course, you hooked me in just the right way. I still have some to lose, but am taking mental notes from your list.

I love it when you go facetious with this. Gaining weight is as easy as spending money. Why, oh, why?

Good tips! Although I disagree with #6, because I personally hate get fixated by a number on the scale (reminds me too much of my friends who've struggled with eating disorders). Plus, muscle weighs more than fat, so the numbers can be misleading. Instead, I know when my pants are starting to get tighter that I need to be better about watching what I eat and working out. And when my clothes get a little looser, I pat myself on the back.

Such a good reminder on keeping on doing the work so that you don't gain the weight back.

Food for thought. Duly noted!

Good luck with those 20 pounds. We should all stick together and lose some weight. please check me out at www.insure-db.com. I have great reads on weight and insurance and all sorts of things. We need to get fit before medicare creaps up and insurance gets too high. Good luck with all the weight loss effort.

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Procedures Performed in the Cardiac Catheterization Laboratory

Diagnostic procedures

Diagnostic cardiac catheterization:

A catheter is inserted through the skin (percutaneous) into an artery, usually in the upper thigh or wrist, and then is threaded through the body's arterial highway to the heart, where a special dye is injected into the coronary arteries to reveal any possible blockages.

A diagnostic procedure to obtain a myocardial tissue sample from the ventricle of the heart aid in the detection of a disease process (i.e., myocarditis, cardiomyopathy, etc.) or to monitor rejection after heart transplant.

Interventional procedures

If the plaque found in an artery has hardened and calcified, a cardiologist can use a rotational atherectomy catheter -- an olive-shaped diamond burr which rotates at very high speed -- to pulverize the plaque into harmless microscopic particles that are washed away by the blood stream.  A laser atherectomy device could also be used in a similar fashion.

Balloon angioplasty (or Percutaneous Transluminal Coronary Angioplasty - PTCA):

A catheter with a balloon on its tip is passed through to a coronary blockage. The balloon is inflated, splitting the plaque and stretching the wall of the coronary vessel to allow more blood flow to the heart muscle.

Percutaneous Coronary Intervention (PCI):

PCI is a non-surgical procedure that uses catheters and tiny wires to treat narrowing (stenosis) of the coronary arteries of the heart found in coronary artery disease. It offers an alternative to bypass surgery and a treatment option for people with angina who have no other options.

Septal closure devices:

A wire mesh device made out of nickel and titanium (Nitinol) and filled with a polyester thread is used to non-surgically close defects in the atrial septum (the wall between the two top chambers of the heart).  A patent foramen ovale (PFO) and atrial septal defect (ASD) are two of the common defects that are closed with this technique.

A stent is a small, metal mesh tube that is placed within a coronary artery after balloon angioplasty to prevent the artery from reclosing (restenosis). There are also drug-eluting stents coated with a special medication to further help prevent re-narrowing of the coronary arteries. Like other coronary stents, it is left permanently in the artery, and slowly releases a drug that prevents the build-up of tissue that leads to restenosis.  Many clinical and anatomic factors go in to the decision as to which type of stent is best for you and will be discussed with you prior to your procedure.

If the artery is noted to have loose debris within it, there are various types of catheters designed to remove the debris from within the artery prior to either angioplasty or stenting.

Make a cardiology appointment

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** Check with your insurance carrier for coverage limitations.

If you can't find a date/time that works for you please call the provider’s office. Not all appointment types at all locations are available online.

Henry Ford Health System is committed to ensuring our Deaf or hard-of-hearing patients and visitors have equal access to all services. We provide the appropriate auxiliary aids and services, including qualified sign language interpreters, TTYs and other assistive listening devices, at no cost. To request assistance, call 313-916-1896 or email

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5 Secrets of "The Bachelor" That You Probably Didn't Know About Until Now

I forced my family into the so-called “Bachelor Nation” the way one would force a square peg through a round hole. We started with the ninth season of The Bachelorette when Desiree Hartsock was in the titular position. It was rich with drama. Chris Harrison was the ringleader of a circus filled with glitzy clothes, people crying, over the top dates, and more people crying. My family resisted at first but were soon fully immersed in Desiree’s journey through what was proclaimed to be “the most dramatic season yet.” No one was more taken by the show than my sister Allison. After watching Chris Soules’ season a few years later, she pulled me aside.

“Anna,” she said seriously. “If I’m not married by the time I’m 26, I need you to nominate me to be on The Bachelor.”

“What? Allison, no. I’m not doing that.”

“Why not?”

“The girls are all insane, you’d be risking career stability, and not to mention the producers probably manipulate all of the contestants to portray them in a way that best suits the narrative they’re trying to build.”

Allison frowned at me and crossed her arms.

“I get it. You don’t think I’m pretty enough.”

That was not it. After reading Amy Kaufman’s book, Bachelor Nation: Inside the World of America’s Favorite Guilty Pleasure, I had gained a better understanding of the shocking production process of the show. I highly recommend this book for anyone interested in reality TV in terms of producing. It was both fascinating and appalling. Here are some highlights.

1. While in the Bachelor Mansion the girls are not allowed to do anything

The producers do not let the girls do anything besides go on and look forward to the dates with The Bachelor /The Bachelorette. No reading, no TV, no outside excursions. This creates something called a “bubble effect.” Without anything to else to focus on, the majority of the contestants’ attention is directed towards their budding relationships, accelerating the development of romantic feelings. Occasionally, producers will use the lack of stimulation to their advantage. For example, if the girls agree to give interviews saying a certain contestant is a bitch, they will be allowed to rent a movie.

2. Chris Harrison was hired as the host because he was made for the friend-zone

Chris Harrison was selected to host the bachelor because he was married and deemed not attractive enough to be a threat to the Bachelor or the Bachelorette’s men. Showrunners did not want to there to be a possibility that any of the girls would go for the host. It was decided that Chris Harrison’s face and body could stop them.

3. There’s a contract for the Neil Lane engagement ring

A major milestone in each season of The Bachelor occurs when the Bachelor or Bachelorette finalists select engagement rings from Neil Lane himself. ABC does not have to pay for these rings because Neil Lane benefits from product placement advertising. Basically, if people see their favorite influencers buying a certain kind of ring on TV, there is a higher likelihood they will buy a ring of that brand. While Bachelor couples are not charged for the ring, there are conditions. If the couple’s relationship breaks off before the two-year mark, they have to return the ring to ABC. If they break up after two years, they earn the right to keep the rock.

4. The producers are ruthless

The story producers on The Bachelor have the hefty task of creating a story out of hours of raw footage. They help the contestants come up with their limo introductions. They ask probing questions that give them words that can be used to support a particular story. Sometimes different sentences are edited together using something called “frankenbiting” to give an interview an entirely different meaning. Even if a producer’s moral compass does not point due north, it makes for great television.

5. The cocktail parties/rose ceremonies take up to twelve hours

Between the individual “in the moment” interviews, introductions, and technical set-up of the rose distribution, the taping of the cocktail parties and rose ceremonies that proceed them can take a while. The contestants pass the time with their allotted two drinks per hour. When the first rose ceremony of this season of The Bachelor was still in full swing at 5 am, Colton drank more iced coffee than he did champagne.

In theory, The Bachelor is a love story where two beautiful people fall for each other under fairytale circumstance. In reality, it is a highly fabricated environment where storylines are cherry-picked from hours upon hours of footage. This is not to say that the final product is any less enjoyable. We know that not every bit of what we watch is true. Allison knows but refuses to acknowledge that any part of the show might be artificial.

“Don’t you dare tell me anything from that stupid book you read!” she yells covering her ears. “You’re going to ruin my entire viewing experience!”

In this case, Allison is able to represent the majority of the American public. We watch this franchise solely for the viewing experience, knowing it shows life through rose-tinted lenses. Even if the contestants are more bored than they let on, and the producers could be classified as manipulative, we watch anyway.

They call it a guilty pleasure for a reason.

Want to keep up with HCBU? Make sure to like us on Facebook, follow us on Instagram, check out our Pinterest board, and read our latest Tweets!


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Hey Dude Vigo Easy Life Brown Leather Work Boot

Code: D10311801
  • Now £59.40
  • (Delivery from £3.95)
Item in Stock | Usually dispatched within 24 hours

Vigo Easy Life Brown Leather Work Boot

Dude Shoes' Vigo has been specifically designed as a winter alternative for our summer customer. This boot features a waxed leather upper with a waterproof lining and is topped with a tumble suede trunk to give the wearer supreme comfort and warmth against the calf.

Lined entirely with faux fur, this lightweight boot weighs in at only 470 grams and features, relaxed wide fit on Dude's leather-lined, memory foam footbed. A winter boot to be left by your door for slipping on whatever the weather - to walk the dogs, stroll along the beach, or pop to the local. Dude shoes are the ultimate relaxed wide, slouchy, feel good, lifestyle shoes.

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Material: Leather/Suede

Sole Unit: Kicker with loprogrip

Weight: 470grms

  • Waxed leather
  • Tumbled suede
  • Waterproof lining to ankle level
  • Faux fur lining

Order cut off time 2.00pm

We will endeavour to dispatch your order as quickly as possible, subject to stock levels. If the dispatch of your order is delayed for any reason we will contact you. All quoted dispatch and delivery times are estimates unless sent by a guaranteed service and are based on standard working days i.e. Monday - Friday.

We will notify you of the courier used to send your order in your dispatch email. All orders sent via Parcelforce will require a signature upon delivery.

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We offer free UK shipping for orders over £100. The shipping costs for orders under £100 are:

United Kingdom Standard Shipping £3.95 - Standard UK and NI orders are shipped with Royal Mail’s Tracked 48 service and should take 48 hours once shipped.

United Kingdom Express Shipping £5.95 - Express UK and NI orders are shipped with Royal Mail's Tracked 24 service and should take 24 hours once shipped. Delivery can take longer during busy periods as a result this shipping option is not a guaranteed service as exact delivery times are out of our control.

UK Next Day delivery £8.00 - Orders for Next Day Delivery will be sent by Parcelforce Next Day service which guarantees next working day delivery in the UK only. Please note Next Day delivery is not available for some postcodes*. Orders placed on a Friday will be delivered on Monday. We do not ship orders over the weekend, so orders placed over the weekend will be dispatched on the following Monday and delivered on Tuesday. (*See restrictions regarding delivery here)

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Deliveries outside of Europe

International delivery (up to 2kg) £18.00 - Each additional 2kg in weight will incur an extra charge of £18.00. International orders are shipped via Royal Mail Signed for Airmail service. Orders are usually delivered within 5-10 working days from dispatching and a signature may be required upon delivery.

We offer free UK returns and you can find out more about how to send your item(s) back here. Unfortunately, we're not able to offer free returns for European or interntional orders at present.

For full delivery and returns terms, please see the Delivery & Returns page for more information.

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