Prevention of Preeclampsia

  • A. Dal Canton
  • G. Romano
  • P. Veniero
Part of the International Yearbooks of Nephrology book series (IYNE, volume 1)


Ideally, treatment to prevent preeclampsia should be limited to patients in whom the disorder can be accurately predicted. Unfortunately, in most cases prediction is impossible since the typical preeclamptic patient is a young primipara with no previous evidence of disease, in whom a sudden rise in blood pressure develops in association with proteinuria and edema. Efforts have been made, however, to find PREDICTIVE TESTS that are of help in anticipating the occurrence of preeclampsia.


Plasma Volume Serum Uric Acid Chronic Hypertension HELLP Syndrome Severe Preeclampsia 
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.


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  1. 1.
    Talledo, O.E., Chelsey, L.C., Zuspan, F.P. Renin-Angiotensin system in normal and toxemic pregnancies. Am. J. Obstet. Gynecol. 100:218–221, 1968.Google Scholar
  2. 2.
    Gant, N.F., Daley, G.L., Chand, S., Whalley, P.J., Mac Donald, P.C. A study of Angiotensin II pressor response throughout primigravid pregnancy. J. Clin. Invest. 52: 2682–2689, 1973.PubMedCrossRefGoogle Scholar
  3. 3.
    Morris, J.A., O’Grady, J.P., Hamilton, C., Davidson, E.C. Vascular reactivity to Angiotensin II infusion during gestation. Am. J. Obstet. Gynecol. 130:379–384, 1978.PubMedGoogle Scholar
  4. 4.
    Orozco, J.Z., Pinsker, V.S., Hernandez, J., Karchmer, S. Valor de la preuba de la Angiotensina II y del “Roll Over Test” como metodos predictivos de la enfermedad hipertensiva aguda del embarazo (preeclampsia/eclampsia). Ginecol. Obstet. Mex. 46:235, 1979.Google Scholar
  5. 5.
    Oney, T., Kaulhausen, H. The value of the Angiotensin sensitivity test in the early diagnosis of hypertensive disorders in pregnancy. Am. J. Obstet. Gyneco 1. 142:17–20, 1982.Google Scholar
  6. 6.
    Gallery, E.D.M., Hunyor, S.N., Gyory A.Z. Plasma volume contraction: a significant factor in both pregnancy-associated hypertension (pre-eclampsia) and chronic hypertension in pregnancy. Quart. J. Med. 192: 593–602, 1979.Google Scholar
  7. 7.
    Goodlin, R.C. Severe pre-eclampsia: another great imitator. Am. J. Obstet. Gynecol. 125:747–752, 1976.PubMedGoogle Scholar
  8. 8.
    Lindt, E., Godfrey, K.A., Otun, H., Philips, P.R. Changes in serum uric acid concentration during normal pregnancy. Br. J. Obstet. Gynecol. 91:128–132, 1984.CrossRefGoogle Scholar
  9. 9.
    Fay, R.A., Bromham, D.R., Brooks, J.A., Gebski, V.J. Platelets and uric acid in prediction of preeclampsia. Am. J. Obstet. Gynecol. 152:1038–1039, 1985.PubMedGoogle Scholar
  10. 10.
    Seitchik, J. Observations on the renal tubular reabsorbtion of uric acid. Normal pregnancy and abnormalpregnancy with and without preeclampsia. Am. J. Obstet. Gynecol. 65:981–985, 1953.PubMedGoogle Scholar
  11. 11.
    Redman, C.W.G., Beilin, L.J., Bonnar, J., Wilkinson, R.H. Plasma-urate measurements in predicting fetal death in hypertensive pregnancy. Lancet 1:1370–73, 1976.PubMedCrossRefGoogle Scholar
  12. 12.
    Burrow, G.N., Ferris, T.F. Medical complication during pregnancy. W.B. Saunders Company, Phyladelphia, 1982.Google Scholar
  13. 13.
    Riedel, H., Eisenbach, G.M., Haeckel, R., Buttner, J. The importance of monitoring uric acid concentrations to evaluate the risk from gestosis. In: Pregnancy Hypertension. M.B. Samour Editor Ain Shams University press, Cairo 83, 1982.Google Scholar
  14. 14.
    Gant, N.F., Chand S., Worley, R.J., Whalley, P.J., Crosby, V.D., Donald, P.C., A clinical test for predicting the development of acute hypertension in pregnancy. Am. J. Obstet. Gynecol. 120:1–7, 1974.PubMedGoogle Scholar
  15. 15.
    Gudson, J.P., Anderson, S.G., May, W.S. A clinical evaluation of the roll-over test for pregnancy induced hypertension. Am J. Obstet. Gynecol. 127:1–3, 1977Google Scholar
  16. 16.
    Marshall, J.W., Newman, R.L. Roll over test. Am. J. Obstet. Gynecol. 127:623–625, 1977.PubMedGoogle Scholar
  17. 17.
    Karbhari, D., Harrigan, J.T., La Magra, R. The supine hypertension test as a predictor of incipient preeclampsia. Am. J. Obstet. Gynecol. 127:620–622, 1977.PubMedGoogle Scholar
  18. 18.
    Tunbridge, R.D.G., Donnai, P. Pregnancy-associated hypertension, a comparison of its prediction by “Roll-Over Test” and plasma Noradrenaline measurement in 100 Primigravidae. Brit. J. Obstet. Gynecol. 90:1027–1032, 1983.CrossRefGoogle Scholar
  19. 19.
    Redman, G.W.G., Bonnar, J., Beilin, L. Early platelet consumption in Preeclampsia. Br. Med. J. 1:467–469, 1978.PubMedCrossRefGoogle Scholar
  20. 20.
    Lazarchick, J., Stubbs, T.M., Romein, L., Van Dorsten, J.P., Loadholt, C.B. Predictive value of fibronectin levels in normotensive gravid women destined to became preeclamptic. Am. J. Obstet. Gynecol. 154:1050–1052, 1986.PubMedGoogle Scholar
  21. 21.
    Erskine, K.J., Iversen, S.A., Davies, R. An altered ratio of 18:2(9, 11) to 18:2(9, 12) linoleic acid in plasma phospholipids as a possible predictor of preeclampsia. Lancet 1, 554–555, 1985.PubMedCrossRefGoogle Scholar
  22. 22.
    Sibai, B.M., Taslini, M., Abdella, T.N., Brooks, T.F., Spinnato, S.A., Anderson, G.D. Maternal and perinatal outcome of coservative management of severe preeclampsia in midtrimester. Am. J. Obstet. Gynecol. 152:32–37, 1985.PubMedGoogle Scholar
  23. 23.
    Anonimous. Hypertension in pregnancy. Lancet 2:487–489, 1975.Google Scholar
  24. 24.
    Dal Canton, A., Altomonte, M., Conte, G., Esposito, C., Fuiano, G., Romano, G., Russo, D., Sabbatini, M., Uccello, F., Veniero, P., Andreucci, V.E. Glomerular dynamics and salt balance in pregnant rats with renal hypertension. Am. J. Physiol, in pressGoogle Scholar
  25. 25.
    Conte, G., Dal Canton, A., Terribile, M., Fuiano, G., Esposito, C., Andreucci, V.E. Exaggerated natriuresis in chronic hypertension in pregnancy. Proc. EDTA-ERA 22:493–497, 1985.Google Scholar
  26. 26.
    Leppert, P., Tisher, C.C., Cheng, S-C.S., Harland, W.R. Antecedent renal disease and the outcome of pregnancy. Ann.Intern.Med. 90:747–751, 1979.PubMedGoogle Scholar
  27. 27.
    Dal Canton, A., Dell’Aglio, P., Olivetti, G., Gardini, F., Benassi, L., Migone, L. EPH-Gestosis isolated and complicating a pre-existing renal disease. Panminerva Medica 19:415–422, 1977.Google Scholar
  28. 28.
    Hayslett, J.P. Interaction of renal disease and pregnancy. Kidney Int. 68:579–587, 1984.CrossRefGoogle Scholar
  29. 29.
    Peters, J.P., Lavietes, P.H., Zimmerman, H.M. Pyelitis in toxemias of pregnancy. Am. J. Obstet. Gynecol. 32:911, 1936.Google Scholar
  30. 30.
    Hill, J.A., Devoe, L.D., Iverson Bryans jr, C. Frequency of asymptomatic bacteriuria in preeclampsia. Obstet. Gynecol. 67:529–532, 1986.PubMedGoogle Scholar
  31. 31.
    Sacks, S.H., Roberts, R., Verrier Jones, K., Asscher, A.W., Ledingham, J.G.G. Effect of symptomless bacteriuria in childood on subsequent pregnancy. Lancet 2:991–994, 1987.PubMedCrossRefGoogle Scholar
  32. 32.
    Bryans, C.L., Torpin, R. A follow up study of two hundred forty-three cases of eclampsia for an average of twelve years. Am. J. Obstet. Gynecol. 58:1054, 1949.PubMedGoogle Scholar
  33. 33.
    Sibai, B.M., El-Nazer, A., Gonzales-Ruiz, A. Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis. Am. J. Obstet. Gynecol. 155:1011–1016, 1986.PubMedGoogle Scholar
  34. 34.
    Chelsey, L.C., Cosgrove, R.A., Annitto, J.E. Pregnancy in the sisters of daughters of eclamptic women. Path. Microbiol. 24:662–666, 1961.Google Scholar
  35. 35.
    Adams, E.M., Finlayson, A. Familial aspects of preeclampsia and hypertension in pregnancy. Lancet 2: 1375–1378, 1961.PubMedCrossRefGoogle Scholar
  36. 36.
    Cooper, D.S., Liston, W.A. Genetic control of severe preeclampsia. J. Med. Genet. 16:409–416, 1979.PubMedCrossRefGoogle Scholar
  37. 37.
    Bower, C., Stanley, F., Walters, B.N.J. Pre-eclampsia and trisomy 13. Lancet 2:1032, 1987.PubMedCrossRefGoogle Scholar
  38. 38.
    Alderman, B.W., Sperling, R.S., Daling, J.R. An epidemiological study of the immunogenetic aetiology of preeclampsia. Br. Med. J. 292:372–374, 1986.CrossRefGoogle Scholar
  39. 39.
    Astin, M., Scott, J.R., Worley, R.J. Preeclampsia/ eclampsia: a fatal father factor. Lancet 2:533, 1981PubMedCrossRefGoogle Scholar
  40. 40.
    McMullan, P.F., Norman, R.J., Marivate, M. Pregnancy-induced hypertension in twin pregnancy. Brit. J. Obstet. Gynecol. 91:240–243, 1984.Google Scholar
  41. 41.
    Symonds, E.M. Genetics of hypertension in pregnancy. Brit. J. Obstet. Gynecol. 93:897, 1986.CrossRefGoogle Scholar
  42. 42.
    Mc Kay, D.G. Chronic intravascular coagulation in normal pregnancy and preeclampsia. Contrib. Nephrol. 25:108–119, 1981.Google Scholar
  43. 43.
    O’Brien, W.F., Saba, I., Knuppel, R.A., Scerbo, J.C., Choen, G.R. Alterations in platelet concentration and aggregation in normal pregnancy and preeclampsia. Am. J.Obstet. Gynecol. 155:486–490, 1986.PubMedGoogle Scholar
  44. 44.
    Bonnar, J., McNicol, G.P., Douglas, A.S. Coagulation and fibrinolytic sisteme in preeclampsia and eclampsia. Brit. Med. J. 2:12–16, 1971.PubMedCrossRefGoogle Scholar
  45. 45.
    Wallenburg, H.C.S., Rotmans, N. Enhanced reactivity of the platelet thromboxane pathway in normotensive and hypertensive pregnancies with insufficient fetal growth. Am. J. Obstet. Gynecol. 144:523–528, 1982.PubMedGoogle Scholar
  46. 46.
    Lindheimer, M.D., Kats, A.I. Pathophysiology of preeclampsia. Ann. Rev. Med. 32:273–289, 1981.PubMedCrossRefGoogle Scholar
  47. 47.
    Beaufils, M., Uzan, S., Donsimoni, R., Colav, J.C. Prevention of preeclampsia by early antiplatelet therapy. Lancet April 13:840–842, 1985.CrossRefGoogle Scholar
  48. 48.
    Wallenburg, H.C.S., Dekker, G.A., Makovitz, J.W., Rotmanss, P. Low-dose aspirin prevents pregnancy-induced hypertension and preeclampsia in angiotensin-sensitive Primigravidae. Lancet 1:1–3, 1986.PubMedCrossRefGoogle Scholar
  49. 49.
    Masotti, G., Galanti, G., Poggesi, L., Abbate, R. Differential inhibition of prostacyclin production and platelet aggregation by aspirin. Lancet 2:1213–1216, 1979PubMedCrossRefGoogle Scholar
  50. 50.
    Rennie, J. Aspirin and preeclampsia. Lancet 1:328, 1986.CrossRefGoogle Scholar
  51. 51.
    Stuard, M.J., Gross, S.J., Elrad, J., Graeber, E. Effects of Acetylsalicilic-acid ingestion on maternal and neonatal hemostasis. N. Engl. J. Med. 307:909–912, 1982.CrossRefGoogle Scholar
  52. 52.
    Buchan, P.C. preeclampsia: a hyperviscosity syndrome. Am. J. Obstet. Gynecol. 142:111–113, 1982.PubMedGoogle Scholar
  53. 53.
    Matthews, J.D., Mason, T.M. Plasma viscosity and preeclampsia. Lancet 2:409, 1974.CrossRefGoogle Scholar
  54. 54.
    Assali, N.S., Vaughn, D.L. Blood volume in preeclampsia: fantasy and reality. Am. J. Obstet. Gynecol. 129: 355–359, 1977.PubMedGoogle Scholar
  55. 55.
    Goodlin, R.C. In defense of conservative management of severe preeclampsia. Am. J. Obstet. Gynecol. 156:924, 1987.Google Scholar
  56. 56.
    Sibai, M., Grossman, R.A., Grossman, H.G. Effects of diuretics on plasma volume in pregnancies with long-term hypertension. Am. J. Obstet. Gynecol. 150:831–835, 1984.PubMedGoogle Scholar
  57. 57.
    Collins, R., Yusuf, S., Peto, R. Overview of randomised trials of diuretics in pregnancy. Brit. Med. J. 290:17–23, 1985.CrossRefGoogle Scholar
  58. 58.
    Chelsey, L. Diagnosis of pre-eclampsia. Obstet. Gynecol. 65:423–425, 1985.Google Scholar
  59. 59.
    Fliegner, J.R. Correction of hypervolemia and central venous pressure monitoring in the management of severe preeclampsia and eclampsia. Am. J. Obstet. Gyneco1. 156: 1041–1042, 1987.Google Scholar
  60. 60.
    Andreucci, V.E., Dal Canton, A., Russo, D. Treatment of chronic hypertension in pregnancy. In “The kidney in pregnancy”, V. E. Andreucci Editor. Martinus Nijhoff Boston, 1986.Google Scholar
  61. 61.
    Liedholm, H., Melander, A. Drug selection in the treatment of pregnancy hypertension. Acta Obstet. Gynecol. Scand. Suppl. 118:49–55, 1984.PubMedCrossRefGoogle Scholar
  62. 62.
    Lundgren, Y., Karlsson, K., Ljungblad, U. Acute haemodynamic effects of pindolol during pregnancy in experimental renal hypertension. Acta Obstet. Gynecol. Scand. suppl. 118:85–90, 1984.PubMedCrossRefGoogle Scholar
  63. 63.
    Lunell, N.O., Nyulund, L., Lewander, R., Sarby, B., Wager, J. Uteroplacental blood flow in pregnancy hypertension after the administration of a beta-adrenoceptor blocker, pindolol. Gynecol. Obstet. Invest. 18:269–274, 1984.PubMedCrossRefGoogle Scholar
  64. 64.
    Sandstrom, B. Clinical trials of adrenergic antagonist in pregnancy hypertension. Acta Obstet. Gynecol. Scand. suppl. 118:57–60, 1984.PubMedCrossRefGoogle Scholar
  65. 65.
    Broughton Pipkin, Turner, F. The effect of angiotensin converting enzyme inhibition in pregnant animals. In: Pregnancy Hypertension ed. M.B. Samour Ain Shams University press, Cairo: 507, 1982.Google Scholar
  66. 66.
    Sibai, B.M., Spinnato, J.A., Watson, D.L., Hill, G.A., Anderson, G.D. Pregnancy outcome in 303 cases with severe preeclampsia. Obstet. Gynecol. 64:319–325, 1984.PubMedGoogle Scholar
  67. 67.
    Martin, T.R., Tupper, W.R.C. The management of severe toxemia in patients at less than 36 weeks’ gestation. Obstet. Gynecol. 54:602–605, 1979.PubMedGoogle Scholar
  68. 68.
    Moore, M.P., Redman, C.W.G. Case control study of severe preeclampsia of early onset. Brit. Med. J. 287:580–583, 1983.CrossRefGoogle Scholar
  69. 69.
    Clark, S.L., Greenspoon, J., Aldahl, D., Phelan, J.P. Severe preeclampsia with persistent oliguria: management of hemodynanic subsets. Am. J. Obstet. Gynecol. 154:490–494, 1986.PubMedGoogle Scholar
  70. 70.
    Gleicher, N., Theofilopoulos, A.N. Immunecomplexes in pregnancy. Lancet 1:216, 1979.PubMedCrossRefGoogle Scholar
  71. 71.
    Weinstein, L. Symdrome of hemolysis, elevated liver enzyme and low platelet count: a severe consequence of hypertension in pregnany. Am. J. Obstet. Gynecol. 142:159–167, 1982.PubMedGoogle Scholar
  72. 72.
    Hibbard, L.T. Maternal mortality due to acute toxemia. Obstet. Gynecol. 42:263–270, 1973.PubMedGoogle Scholar
  73. 73.
    Andersen, W.A., Harbert, G.M. Conservative management of preeclamptic and eclamptic patients:a reevalutation. Am. J. Obstet. Gynecol. 129:260–267, 1977.PubMedGoogle Scholar
  74. 74.
    Lin, C.C., Lindheimer, M.D., River, P., Moawad, A.H. Fetal outcome in hypertensive disorders of pregnancy. Am. J. Obstet. Gynecol. 142:255–260, 1982.PubMedGoogle Scholar
  75. 75.
    Dillon, W.P., Egan, E.A. Aggressive obstetric management in late second-trimester deliveries. Obstet. Gynecol. 58:685–690, 1981.PubMedGoogle Scholar
  76. 76.
    Ricke, P.S., Elliot, J.P., Freeman, R.K. Use of corticosteroids in pregnancy-induced hypertension. Obstet. Gynecol. 55:206–210, 1980.PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • A. Dal Canton
    • 1
  • G. Romano
    • 2
  • P. Veniero
    • 2
  1. 1.Division of Nephrology, Faculty of Medicine at CatanzaroUniversity of Reggio CalabriaCatanzaroItaly
  2. 2.Department of Nephrology, II Faculty of MedicineUniversity of NaplesNaplesItaly

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