title: Recent biomarkers for the identification of patients at risk for preeclampsia: the role of uteroplacental ischemia.
abstract: BACKGROUND
  The prediction and early diagnosis of preeclampsia remains limited due to its heterogeneous clinical presentation and unclear pathophysiology. However, accumulating evidence indicates that angiogenic imbalances during pregnancy may play a central role in the mechanisms of injury of preeclampsia. Moreover, a growing body of evidence suggests that a combination of biochemical and biophysical parameters in the first and second trimester may contribute to the identification of patients at high risk of early-onset and/or severe preeclampsia.
  
  
  METHODS
  This article reviews proposed mechanisms of injury in preeclampsia as well as recent attempts in the prediction of this pregnancy complication. The article also highlights the limitations of these studies, in particular their low positive predictive value, indicating that any prophylactic intervention would expose a large number of patients who would not develop the disease.
  
  
  CONCLUSIONS
  The prediction of early-onset preeclampsia using biochemical and biophysical parameters or the combination of both is in general better than the prediction of late-onset preeclampsia. We propose a conceptual framework whereby the timing of presentation of preeclampsia may be a function of the timing of the insults to the fetal supply line as well as a function of the fetal response to these insults.
authors.affiliation: William Beaumont Hospital, Department of Obstetrics and Gynecology , 3601 West Thirteen Mile Road, Royal Oak, MI 48073 , USA +1 248 898 5128 ; jimmy.espinoza@beaumont.edu.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza