References

Altman D, Carroli G, Duley L Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002; 359:(9321)1877-90

Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013; 122:(5)1122-31

Bellamy L, Casas J-P, Hingorani AD, Williams DJ Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007; 335:(7627)

Boers KE, Vijgen SM, Bijlenga D Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ. 2010; 341

Bramham K, Nelson-Piercy C, Brown MJ, Chappell LC Postpartum management of hypertension. BMJ. 2013; 346

Bramham K, Parnell B, Nelson-Piercy C Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014; 348

Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011; 118:1-203

Chappell LC, Shennan AH Assessment of proteinuria in pregnancy. BMJ. 2008; 336:968-9

Chappell LC, Enye S, Seed P, Briley AL, Poston L, Shennan AH Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: A prospective study. Hypertension. 2008; 51:1002-9

Churchill D, Duley L, Thornton JG, Jones L Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation. Cochrane Database Syst Rev. 2013; 7 https://doi.org/10.1002/14651858.CD003106.pub2

Dugoff L, Hobbins JC, Malone FD First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). Am J Obstet Gynecol. 2004; 191:(4)1446-51

Duley L The global impact of pre-eclampsia and eclampsia. Seminars in Perinatology. 2009; 130-7

Duley L, Meher S, Jones L Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev. 2013; 7 https://doi.org/10.1002/14651858.CD001449.pub3

Engels T, Pape J, Schoofs K, Henrich W, Verlohren S Automated measurement of sFlt1, PlGF and sFlt1/PlGF ratio in differential diagnosis of hypertensive pregnancy disorders. Hypertens Pregnancy. 2013; 32:(4)459-73

Granger JP, Alexander BT, Llinas MT, Bennett WA, Khalil RA Pathophysiology of hypertension during preeclampsia linking placental ischemia with endothelial dysfunction. Hypertension. 2001; 38:(3 Pt 2)718-22

Irgens HU, Reisaeter L, Irgens LM, Lie RT Long term mortality of mothers and fathers after pre-eclampsia: population based cohort study. BMJ. 2001; 323:(7323)1213-7

Knight M, Kenyon S, Brocklehurst P Saving Lives, Improving Mothers' Care—Lessons learned to inform future maternity care from the UK and Ireland.Oxford: CMACE; 2014

Koopmans CM, Bijlenga D, Groen H, Vijgen SMC, Aarnoudse JG, Bekedam DJ Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 2009; 374:(9694)979-88

Milne F, Redman C, Walker J Assessing the onset of pre-eclampsia in the hospital day unit: summary of the pre-eclampsia guideline (PRECOG II). BMJ. 2009; 339

London: NICE; 2010

Onwudiwe N, Yu CK, Poon LC Prediction of pre-eclampsia by a combination of maternal history, uterine artery Doppler and mean arterial pressure. Ultrasound Obstet Gynecol. 2008; 32:(7)877-83

Petrie JC, O'Brien ET, Littler WA, de Swiet M Recommendations on blood pressure measurement. BMJ (Clin Res Ed). 1986; 293:(6547)611-5

Poon LC, Chelemen T, Granvillano O First-trimester maternal serum a disintegrin and metalloprotease 12 (ADAM12) and adverse pregnancy outcome. Obstet Gynecol. 2008; 112:(5)1082-90

Poon LC, Syngelaki A, Akolekar R Combined screening for preeclampsia and small for gestational age at 11-13 weeks. Fetal Diagn Ther. 2013; 33:(1)16-27

Poon LC, Nicolaides KH Early prediction of preeclampsia. Obstet Gynecol Int. 2014a; 2014:297-397

Poon LC, Nicolaides KH First-trimester maternal factors and biomarker screening for preeclampsia. Prenatal Diagnosis. 2014b; 34:(7)618-27

Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study. Lancet. 2005; 366:(9499)1797-803

Redman CW Current topic: pre-eclampsia and the placenta. Placenta. 1991; 12:(4)301-8

Roberts JM, Redman CW Pre-eclampsia: more than pregnancy-induced hypertension. Lancet. 1993; 341:(8858)1447-51

Romero R, Kusanovic JP, Than NG First-trimester maternal serum PP13 in the risk assessment for preeclampsia. Am J Obstet Gynecol. 2008; 199:(2)122.e1-122.e11

Smith GC, Pell JP, Walsh D Pregnancy complications and maternal risk of ischaemic heart disease: a retrospective cohort study of 129,290 births. Lancet. 2001; 357:(9273)2002-6

Steegers EAP, von Dadelszen P, Duvekot JJ, Pijnenborg R Pre-eclampsia. Lancet. 2010; 21376:(9741)631-44

Stock SJ, Ferguson E, Duffy A Outcomes of elective induction of labour compared with expectant management: population based study. BMJ. 2012; 344

Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens An Int J Women's Cardiovasc Heal. 2014; 4:(2)97-104

Thangaratinam S, Ismail KM, Sharp S Accuracy of serum uric acid in predicting complications of pre-eclampsia: a systematic review. BJOG. 2006; 113:(4)369-78

Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial. Lancet. 1995; 345:(8963)1455-63

Verlohren S, Galindo A, Schlembach D, Zeisler H, Herraiz I, Moertl MG An automated method for the determination of the sFlt-1/PIGF ratio in the assessment of preeclampsia. Am J Obstet Gynecol. 2010; 202:(2)161.e1-161.e11

Villa PM, Kajantie E, Räikkönen K Aspirin in the prevention of pre-eclampsia in high-risk women: a randomised placebo-controlled PREDO Trial and a meta-analysis of randomised trials. BJOG. 2013; 120:(1)64-74

Geneva: WHO; 2005

Geneva: WHO; 2011

Diagnosis and management of pre-eclampsia: A clinical perspective on recent advances in the field

02 April 2015
14 min read
Volume 23 · Issue 4

Abstract

The hypertensive disorders of pregnancy encompass pre-eclampsia, pregnancy induced hypertension and essential hypertension, which may be complicated by superimposed pre-eclampsia. They represent a significant contributor to maternal and neonatal morbidity worldwide. A sound understanding of the pathophysiology and management of the disease is essential to safe and effective care of all women in pregnancy.

In addition, hypertension in pregnancy is associated with health risks in later life and detection in pregnancy represents an opportunity to provide women with health information that may protect them and their babies in later life.

This article addresses the current understanding of the pathophysiology of pre-eclampsia and the hypertensive disorders of pregnancy and presents the latest developments in screening, diagnosis and management of the disease.

Pre-eclampsia is a global health problem, which complicates 2–8% of all pregnancies and contributes to 15% of preterm births and 9–26% of maternal deaths worldwide (World Health Organization (WHO), 2005; Duley, 2009; Steegers et al, 2010). The incidence of pre-eclampsia is likely to have increased yet further with the global increase in maternal age, obesity, assisted reproductive techniques and medical comorbidities that predispose women to pre-eclampsia, such as diabetes, hypertension and renal disease.

In simple terms, pre-eclampsia is thought to arise from failure of the normal development of the maternal–fetal interface in the placenta (Redman, 1991; Roberts and Redman, 1993; Granger et al, 2001); however, the precise mechanism remains unknown. Rapid advances in understanding have opened up new avenues of exploration in screening for, and prevention of, pre-eclampsia with the potential to significantly improve outcomes in the future. The aetiology of the disease is multifactorial and interventions for prevention and management will need to address a wide range of factors incorporating lifestyle and diet modification, and multidisciplinary care. Pre-eclampsia is a risk to health not only in the immediate peripartum period—women who have suffered from pre-eclampsia are at increased risk of cardiovascular disease throughout life (Irgens et al, 2001; Smith et al, 2001; Ray et al, 2005; Bellamy et al, 2007).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

  • Monthly email newsletter