References

Akolekar R, Syngelaki A, Poon L, Wright D, Nicolaides KH. Competing risks model in early screening for pre-eclampsia by biophysical and biochemical markers. Fetal Diagn Ther. 2013; 33:(1)8-15 https://doi.org/https://doi.org/10.1159/000341264

Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013; 122:(5)1122-31 https://doi.org/https://doi.org/10.1097/01. AOG.0000437382.03963.88

Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Obstet Gynecol Surv. 2007; 62:(11)697-9 https://doi.org/https://doi.org/10.1097/01.ogx.0000286575.95522.54

Atallah A, Lecarpentier E, Goffinet F, Doret-Dion M, Gaucherand P, Tsatsaris V. Aspirin for prevention of preeclampsia. Drugs. 2017; 77:(17)1819-31 https://doi.org/https://doi.org/10.1007/s40265-017-0823-0

Bartsch E, Medcalf KE, Park AL, Ray JG. Clinical risk factors for pre-eclampsia determine in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016; 353

Bilano VL, Ota E, Ganchimeg T, Mori R, Souza JP. Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low-and middle-income countries: a WHO secondary analysis. PLoS ONE. 2014; 9:(3) https://doi.org/https://doi.org/10.1371/journal.pone.0091198

Blackburn ST. Maternal, Fetal & Neonatal Physiology, 5th edn. Maryland Heights, MO: Elsevier; 2017

Cadavid AP. Aspirin: the mechanism of action revisited in the context of pregnancy complications. Front Immunol. 2017; 8 https://doi.org/https://doi.org/10.3389/fimmu.2017.00261

Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol. 2014a; 10:(8)466-80 https://doi.org/https://doi.org/10.1038/nrneph.2014.102

Chaiworapongsa T, Chaemsaithong P, Korzeniewski SJ, Yeo L, Romero R. Pre-eclampsia part 2: prediction, prevention and management. Nat Revs Nephrol. 2014b; 10:(9)531-40 https://doi.org/https://doi.org/10.1038/nrneph.2014.103

Crowther CA, Middleton PF, Voysey M, Askie L, Duley L, Pryde PG. Assessing the neuroprotective benefits for babies of antenatal magnesium sulphate: An individual participant data meta-analysis. PLOS Med. 2017; 14:(10) https://doi.org/https://doi.org/10.1371/journal.pmed.1002398

Dhariwal NK, Lynde GC. Update in the management of patients with pre-eclampsia. Anesthesiol Clin. 2017; 35:(1)95-106 https://doi.org/https://doi.org/10.1016/j.anclin.2016.09.009

Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009; 33:(3)130-7 https://doi.org/https://doi.org/10.1053/j.semperi.2009.02.010

Fisher SJ. Why is placentation abnormal in pre-eclampsia?. Am J Obstet Gynecol. 2015; 213:(4)S115-22 https://doi.org/https://doi.org/10.1016/j.ajog.2015.08.042

Foo L, Masini G, McEniery C, Wilkinson I, Bennett P, Lees C. OC07.01: Pre-conception maternal hemodynamics is associated with subsequent development of pre-eclampsia (PE) or intrauterine growth restriction (IUGR). Ultrasound Obstet Gynecol. 2017; 50:12-13 https://doi.org/https://doi.org/10.1002/uog.17600

Giguère Y, Charland M, Thériault S Linking pre-eclampsia and cardiovascular disease later in life. Clin Chem Laboratory Med. 2012; 50:(6)985-93 https://doi.org/https://doi.org/10.1515/cclm.2011.764

Hakim J, Senterman MK, Hakim AM. Pre-eclampsia is a biomarker for vascular disease in both mother and child: the need for a medical alert system. Int J Pediatr. 2013; 2013:1-8 https://doi.org/https://doi.org/10.1155/2013/953150

Hunter LA, Gibbins KJ. Magnesium sulfate: past, present, and future. J Midwifery Womens Health. 2011; 56:(6)566-74 https://doi.org/10.1111/j.1542-2011.2011.00121.x

Jordan S. Pharmacology for Midwives the evidence base for safe practice, 2nd edn. New York, NY: Palgrave Macmilan; 2010

Mol BW, Roberts CT, Thangaratinam S, Magee LA, De Groot CJ, Hofmeyr GJ. Pre-eclampsia. Lancet. 2016; 387:(10022)999-1011 https://doi.org/https://doi.org/10.1016/s0140-6736(15)00070-7

Myatt L, Roberts JM. Pre-eclampsia: syndrome or disease?. Curr Hypertens Rep. 2015; 17:(11) https://doi.org/https://doi.org/10.1007/s11906-015-0595-4

Saving Lives, Improving Mothers' Care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013–15. In: Knight M, Nair M, Tuffnell D (eds). Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2017

Hypertension in pregnancy.London: NICE; 2010

National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management [CG107]. 2011. https://www.nice.org.uk/guidance/cg107/chapter/1-Guidance (accessed 9 April 2018)

Nelson DB, Ziadie MS, McIntire DD, Rogers BB, Leveno KJ. Placental pathology suggesting that pre-eclampsia is more than one disease. Am J Obstet Gynecol. 2014; 210:(1)66.e1-7 https://doi.org/https://doi.org/10.1016/j.ajog.2013.09.010

O'Gorman N, Wright D, Syngelaki A. Competing risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol. 2016; 214:(1)103.e1-12 https://doi.org/https://doi.org/10.1016/j.ajog.2015.08.034

Park H, Shim S, Cha D. Combined screening for early detection of pre-eclampsia. Int J Mol Sci. 2015; 16:(8)17952-74 https://doi.org/https://doi.org/10.3390/ijms160817952

Phillips C, Boyd M. Assessment, management, and health implications of early-onset pre-eclampsia. Nurs Womens Health. 2016; 20:(4)400-14 https://doi.org/https://doi.org/10.1016/j.nwh.2016.07.003

Powe CE, Levine RJ, Karumanchi SA. Pre-eclampsia, a disease of the maternal endothelium: the role of antiangiogenic factors and implications for later cardiovascular disease. Circulation. 2011; 123:(24)2856-69 https://doi.org/https://doi.org/10.1161/circulationaha.109.853127

Rang HP, Ritter JM, Flowe RJ, Henderson G. Rang & Dale's Pharmacology, 8th edn. London: Churchill Livingston; 2016

Redman C W, Sargent IL. Immunology of pre-eclampsia. Am J Reproduct Immunol. 2010; 63:(6)534-43 https://doi.org/https://doi.org/10.1111/j.1600-0897.2010.00831.x

Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of pre-eclampsia and fetal growth restriction: systematic review and met-analysis. Am J Obstet Gynecol. 2017; 216:(2)110-120 https://doi.org/https://doi.org/10.1016/j.ajog.2016.09.076

Roberts JM, Bell MJ. If we know so much about pre-eclampsia, why haven't we cured the disease?. J Reproduct Immunol. 2013; 99:(1-2)1-9 https://doi.org/https://doi.org/10.1016/j.jri.2013.05.003

Roberts JM, Himes KP. Pre-eclampsia: Screening and aspirin therapy for prevention of pre-eclampsia. Nat Rev Nephrol. 2017; 13:(10)602-4 https://doi.org/https://doi.org/10.1038/nrneph.2017.121

Rolnik DL, Wright D, Poon LC. Aspirin versus placebo in pregnancies at high risk for preterm pre-eclampsia. N Engl J Med. 2017; 377:(7)613-22 https://doi.org/https://doi.org/10.1056/nejmoa1704559

Saftlas AF, Rubenstein L, Prater K, Harland KK, Field E, Triche EW. Cumulative exposure to paternal seminal fluid prior to conception and subsequent risk of pre-eclampsia. J Reproduct Immunol. 2014; 101-2 https://doi.org/https://doi.org/10.1016/j.jri.2013.07.006

Shepherd E, Salam RA, Middleton P Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2017; 8 https://doi.org/https://doi.org/10.1002/14651858.CD012077.pub2

Spradley F, Palei A, Granger J. Immune mechanisms linking obesity and pre-eclampsia. Biomolecules. 2015; 5:(4)3142-76 https://doi.org/https://doi.org/10.3390/biom5043142

Story L, Chappell LC. Preterm pre-eclampsia: What every neonatologist should know. Early Hum Dev. 2017; 114:26-30 https://doi.org/https://doi.org/10.1016/j.earlhumdev.2017.09.010

Tan MY, Wright D, Syngelaki A Ultrasound Obst Gynecol. 2018; https://doi.org/https://doi.org/10.1002/uog.19039

Wright D, Syngelaki A, Akolekar R, Poon LC, Nicolaides KH. Competing risks model in screening for pre-eclampsia by maternal characteristics and medical history. Am J Obstet Gynecol. 2015; 213:(1)62.e1-10 https://doi.org/https://doi.org/10.1016/j.ajog.2015.02.018

Wylie L, Bryce HG. The midwives' guide to key medical conditions: pregnancy and childbirth.Philadelphia: Elsevier Health Sciences, PA; 2016

Pre-eclampsia: Pathophysiology, screening and prophylaxis

02 May 2018
15 min read
Volume 26 · Issue 5

Abstract

Pre-eclampsia is a pregnancy-specific disorder that can significantly alter maternal physiology and result in a considerable threat to maternal and fetal health. Although many of the mechanisms involved in its pathophysiology have been elucidated, significant knowledge gaps remain. Perhaps as a result, there is no known treatment for the condition, and birth is the only known cure. The optimal timing of birth can present a difficult decision in the face of maternal or fetal demise; therefore maternal and fetal condition must be monitored and stabilised with the aim of prolonging pregnancy until this time is evident, or until birth becomes necessary. Intervention involves screening pregnant women with the aim of initiating aspirin prophylaxis for those deemed to be at increased risk. This article discusses the pathophysiological mechanisms involved in pre-eclampsia, factors that may impact on pathophysiology, controversies around screening, and the mechanism of aspirin prophylaxis.

Pre-eclampsia is a pregnancy-specific, multisystem disorder that affects 3-5% of all pregnancies (Phillips and Boyd, 2016; Story and Chappell, 2017). It can affect many organs, including the kidneys, liver, vasculature, and brain, through reduced perfusion, endothelial damage, oedema, and ischaemia—all of which are highly detrimental to organ function and can result in maternal death (Dhariwal and Lynde, 2016). There are also adverse consequences for the fetus, because the pathology of pre-eclampsia is thought to originate in the placenta, and also because iatrogenic preterm birth is often necessary to prevent maternal and/or fetal demise (Story and Chappel, 2017). Pre-eclampsia is therefore a significant cause of maternal and perinatal morbidity and mortality worldwide (Dhariwal and Lynde, 2016; Roberts and Himes, 2017), although in high-income countries, maternal deaths due to pre-eclampsia have declined dramatically in recent years (Knight and Nair, 2017). However, in low-income countries, pre-eclampsia still represents a significant cause of maternal mortality (Bilano et al, 2014). Here, improved access to antenatal care can significantly reduce morbidity and mortality associated with this disease (Duley, 2009; Bilano et al, 2014).

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