Pre-eclampsia.
Pre-eclampsia is a major cause of maternal mortality (15-20% in developed countries) and morbidities (acute and long-term), perinatal deaths, preterm birth, and intrauterine growth restriction. Key findings support a causal or pathogenetic model of superficial placentation driven by immune maladaptation, with subsequently reduced concentrations of angiogenic growth factors and increased placental debris in the maternal circulation resulting in a (mainly hypertensive) maternal inflammatory response. The final phenotype, maternal pre-eclamptic syndrome, is further modulated by pre-existing maternal cardiovascular or metabolic fitness. Currently, women at risk are identified on the basis of epidemiological and clinical risk factors, but the diagnostic criteria of pre-eclampsia remain unclear, with no known biomarkers. Treatment is still prenatal care, timely diagnosis, proper management, and timely delivery. Many interventions to lengthen pregnancy (eg, treatment for mild hypertension, plasma-volume expansion, and corticosteroid use) have a poor evidence base. We review findings on the diagnosis, risk factors, and pathogenesis of pre-eclampsia and the present status of its prediction, prevention, and management.
Sibai
Baha
B
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0526, Cincinnati, OH 45267, USA. baha.sibai@uc.edu
Dekker
Gus
G
Kupferminc
Michael
M
D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome