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Pre-eclampsia: An Update

  • Peter von DadelszenEmail author
  • Laura A. Magee
Hypertensive Emergencies (BM Baumann, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hypertensive Emergencies

Abstract

Pre-eclampsia remains the second leading direct cause of maternal death, >99 % of which occurs in less developed countries. Over 90 percent of the observed reduction in pre-eclampsia-related maternal deaths in the UK (1952–2008) occurred with antenatal surveillance and timed delivery. In this review, we discuss the pathogenesis, diagnostic criteria, disease prediction models, prevention and management of pre-eclampsia. The Pre-eclampsia Integrated Estimate of RiSk (PIERS) models and markers of angiogenic imbalance identify women at incremental risk for severe pre-eclampsia complications. For women at high risk of developing pre-eclampsia, low doses of aspirin (especially if started <17 weeks) and calcium are evidence-based preventative strategies; heparin is less so. Severe hypertension must be treated and the Control of Hypertension In Pregnancy (CHIPS) Trial (reporting: 2014) will guide non-severe hypertension management. Magnesium sulfate prevents and treats eclampsia; there is insufficient evidence to support alternative regimens. Pre-eclampsia predicts later cardiovascular disease; however, at this time we do not know what to do about it.

Keywords

Pre-eclampsia Pregnancy hypertension Classification Pathogenesis Risk factors Prediction Angiogenic factors Metabolomics Proteomics Prevention Heparin Aspirin Calcium Diagnosis Risk stratification Outcome prediction Timing of delivery Antihypertensive management Magnesium sulfate Eclampsia Fetal neuroprotection Long-term outcomes 

Notes

Acknowledgments

Peter von Dadelszen and Laura Magee receive salary support from the Child and Family Research Institute (both), the University of British Columbia (PvD) and BC Women’s Hospital and Health Centre (LAM). Professor James Walker (UK) first presented the data shown in the figure to us. PRE-EMPT is funded by the University of British Columbia, a grantee of the Bill & Melinda Gates Foundation and the fullPIERS project and CHIPS Trial by the Canadian Institutes of Health Research.

Compliance with Ethics Guidelines

Conflict of Interest Peter von Dadelszen has received an unrestricted grant-in-aid to support PlGF-related research, particularly related to IUGR. He has also received consultancy fees from Alere International and payments from Christiana Healthcare for work in a DSMB related to an RCT of antibiotics for group B streptococcus in pregnancy. Dr. von Dadelszen receives salary support from the Child & Family Research Institute, UBC.

Laura A. Magee has received consultancy fees from Alere International and salary support from the Child & Family Research Institute, UBC, and from BC Women’s Hospital.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyUniversity of British ColumbiaVancouverCanada
  2. 2.Department of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.The Child and Family Research InstituteUniversity of British ColumbiaVancouverCanada

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