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Geneva: WHO; 2005

Geneva: WHO; 2011

Diagnosis and management of pre-eclampsia: A clinical perspective on recent advances in the field

02 April 2015
Clinical Practice
02 April 2015
Volume 23 · Issue 4

Abstract

The hypertensive disorders of pregnancy encompass pre-eclampsia, pregnancy induced hypertension and essential hypertension, which may be complicated by superimposed pre-eclampsia. They represent a significant contributor to maternal and neonatal morbidity worldwide. A sound understanding of the pathophysiology and management of the disease is essential to safe and effective care of all women in pregnancy.

In addition, hypertension in pregnancy is associated with health risks in later life and detection in pregnancy represents an opportunity to provide women with health information that may protect them and their babies in later life.

This article addresses the current understanding of the pathophysiology of pre-eclampsia and the hypertensive disorders of pregnancy and presents the latest developments in screening, diagnosis and management of the disease.

Pre-eclampsia is a global health problem, which complicates 2–8% of all pregnancies and contributes to 15% of preterm births and 9–26% of maternal deaths worldwide (World Health Organization (WHO), 2005; Duley, 2009; Steegers et al, 2010). The incidence of pre-eclampsia is likely to have increased yet further with the global increase in maternal age, obesity, assisted reproductive techniques and medical comorbidities that predispose women to pre-eclampsia, such as diabetes, hypertension and renal disease.

In simple terms, pre-eclampsia is thought to arise from failure of the normal development of the maternal–fetal interface in the placenta (Redman, 1991; Roberts and Redman, 1993; Granger et al, 2001); however, the precise mechanism remains unknown. Rapid advances in understanding have opened up new avenues of exploration in screening for, and prevention of, pre-eclampsia with the potential to significantly improve outcomes in the future. The aetiology of the disease is multifactorial and interventions for prevention and management will need to address a wide range of factors incorporating lifestyle and diet modification, and multidisciplinary care. Pre-eclampsia is a risk to health not only in the immediate peripartum period—women who have suffered from pre-eclampsia are at increased risk of cardiovascular disease throughout life (Irgens et al, 2001; Smith et al, 2001; Ray et al, 2005; Bellamy et al, 2007).

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Pre-eclampsia
Eclampsia
Gestational hypertension
Blood pressure
Pregnancy screening
Management
Treatment
Outcome