Pre-eclampsia: Pathophysiology, screening and prophylaxis
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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