It is a serious hypertensive disease in pregnancy. Affects 4-8 % of pregnant women.
How does preeclampsia manifest itself?
Preeclampsia (PE) is defined as a new incidence of hypertension (> 140/90 mmHg) or proteinuria (≥ 0.3 g / 24 h) after 20 weeks of gestation
PE is caused by a dysbalance of placental angiogenic and anti-angiogenic factors. The risk of PE can already be determined during screening in the first trimester.
Which pregnant women are at increased risk of preeclampsia?
• personal or family history of pre-eclampsia
• first pregnancy
• under 18 or over 30 years of age
• fertilization by assisted reproduction (IVF)
• multiple pregnancies
• pregnancy diabetes
• vitamin deficiency
• some diseases before pregnancy – hypertension, diabetes, migraines, rheumatoid arthritis, kidney disease
The most serious consequences of PE for the mother:
– eclampsia, HELLP syndrome, pulmonary edema
– high risk of cardiovascular disease
chronic hypertension, stroke. kidney damage
– women with a history of PE have a 2-fold risk
stroke death compared to stroke, women without PE
The most serious consequences of PE for the fetus:
– premature delivery
– low birth weight
– respiratory distress syndrome
– complications of premature labor (cerebral palsy,
visual impairment, blindness
– increased risk of stroke, coronary heart disease in adulthood
– metabolic syndrome
Contemporary diagnostic „gold standard“
Currently, blood pressure measurement and proteinuria are used to diagnose PE. These tests have low sensitivity and specificity – a positive predictive value is 20 %.
Dysbalance of angiogenic factors
At present, the method of choice for diagnosis of PE is to determine the imbalance of angiogenic factors. This can be ascertained before the clinical signs of PE.
As part of the first trimestr screening of Down syndrome, we determine PlGF (placental growth hormone) in blood of the women. This parameter is then included in the algorithm for calculating the risk of fetal affection with Down syndrome, and the risk assessment of preeclampsia is determined by the evaluation software. Average arterial pressure and blood flow in uterine arteries are included in the calculation.
What are the treatment options if there is a high risk of PE?
In case of positive PE screening in the first trimester, timely administration of 150 mg aspirin daily can reduce the incidence of early PE by 90 % according to the ASPRE study !!!
Akolekar R. Competing risks model in early screening for preeclampsia by biophysical and biochemical markers. Fetal Diag Ther 2013; 33 (1): 8-15.
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