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Early-Onset Preeclampsia and HELLP Syndrome: An Overview

  • Nandor Gabor Than
  • Edi Vaisbuch
  • Chong Jai Kim
  • Shali Mazaki-Tovi
  • Offer Erez
  • Lami Yeo
  • Pooja Mittal
  • Petronella Hupuczi
  • Tibor Varkonyi
  • Sonia S. Hassan
  • Zoltan Papp
  • Roberto Romero
Chapter

Abstract

Preeclampsia, one of the “great obstetrical syndromes,” affects ~3–5% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Preeclampsia is diagnosed after 20 weeks of gestation and is characterized by new-onset hypertension and proteinuria in previously normotensive women, which may deteriorate into maternal multiorgan damage affecting the kidneys, liver and central nervous system. This multisystem disorder is unique to human pregnancy and is the clinical manifestation of heterogeneous pathological processes. The placenta plays a key role in the underlying mechanisms leading to the development of preeclampsia as the only definitive treatment today remains delivery. Early-onset preeclampsia often has severe maternal and foetal consequences including intrauterine growth restriction, preterm delivery, low or very low birth weight, increased perinatal morbidity and mortality and a high incidence of the life-threatening HELLP syndrome, while the clinical presentation of late-onset preeclampsia is frequently mild, resulting mainly in maternal consequences. Of further importance, pregnant women with severe forms of preeclampsia and their growth-restricted foetuses are at an increased risk for developing cardiovascular disease later in life. Here we review the literature on the epidemiology, risk factors, pathophysiology, maternal and perinatal outcomes, diagnosis and management of early-onset preeclampsia and HELLP syndrome and summarize how these severe pregnancy complications are related to foetal growth and health.

Keywords

Uterine Artery Expectant Management HELLP Syndrome Severe Preeclampsia Spiral Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ADAM12

A disintegrin and metalloproteinase domain 12

AGA

Appropriate-for-gestational age

beta-hCG

Human chorionic gonadotropin beta subunit

BMI

Body mass index

cffDNA

Cell-free foetal DNA

DIC

Disseminated intravascular coagulation

FGR

Foetal growth restriction

HLA

Human leukocyte antigen

HELLPsyndrome

Haemolysis, elevated liver enzymes, low platelets syndrome

IUFD

Intrauterine foetal death

IUGR

Intrauterine growth restriction

IVH

Intraventricular haemorrhage

KIR

Killer-cell immunoglobulin-like receptors

LGA

Large-for-gestational age

NICU

Neonatal intensive care unit

NKcell

Natural killer cell

NO

Nitric oxide

PAPP-A

Pregnancy-associated plasma protein A

PlGF

Placenta growth factor

PP13

Placental Protein 13

RBP-4

Retinol-binding protein 4

RDS

Respiratory distress syndrome

ROS

Reactive oxygen species

sEng

Soluble endoglin

SGA

Small-for-gestational age

sVEGFR-1

Soluble receptor for vascular endothelial growth factor-1

TNF-α

Tumour necrosis factor-α

VEGF

Vascular endothelial growth factor

Notes

Acknowledgments

This work was supported in part by the Perinatology Research Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS. Figure 113.2 was adapted from and used with permission by Romero et al. (2008).

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nandor Gabor Than
    • 1
  • Edi Vaisbuch
    • 1
  • Chong Jai Kim
    • 1
  • Shali Mazaki-Tovi
    • 5
  • Offer Erez
    • 1
    • 2
  • Lami Yeo
    • 1
  • Pooja Mittal
    • 1
  • Petronella Hupuczi
    • 3
  • Tibor Varkonyi
    • 4
  • Sonia S. Hassan
    • 1
  • Zoltan Papp
    • 4
  • Roberto Romero
    • 1
  1. 1.Perinatology Research Branch, NICHD/NIH/DHHS, Wayne State UniversityDetroitUSA
  2. 2.Department of Obstetrics and Gynecology “B”, Faculty of Health SciencesSoroka University Medical Center, Ben Gurion University of the NegevBeer ShevaIsrael
  3. 3.Department of Anaesthesiology and Intensive TherapySemmelweis UniversityBudapestHungary
  4. 4.1st Department of Obstetrics and GynaecologySemmelweis UniversityBudapestHungary
  5. 5.Perinatology Research Branch, NICHD/NIH/DHHS, Wayne State UniversityDetroitUSA

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