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Current developments in managing preeclampsia

Rosemary Townsend, Patrick O'Brien, Asma Khalil
Preeclampsia is a potentially serious complication of pregnancy with increasing significance worldwide. Preeclampsia is the cause of 9%-26% of global maternal mortality and a significant proportion of preterm delivery, and maternal and neonatal morbidity. Incidence is increasing in keeping with the increase in obesity, maternal age, and women with medical comorbidities entering pregnancy. Recent developments in the understanding of the pathophysiology of preeclampsia have opened new avenues for prevention, screening, and management of this condition...
2016: Integrated Blood Pressure Control
Karst Y Heida, Michiel L Bots, Christianne Jm de Groot, Frederique M van Dunné, Nurah M Hammoud, Annemiek Hoek, Joop Se Laven, Angela Hem Maas, Jeanine E Roeters van Lennep, Birgitta K Velthuis, Arie Franx
BACKGROUND: In the past decades evidence has accumulated that women with reproductive and pregnancy-related disorders are at increased risk of developing cardiovascular disease (CVD) in the future. Up to now there is no standardised follow-up of these women becausee guidelines on cardiovascular risk management for this group are lacking. However, early identification of high-risk populations followed by prevention and treatment of CVD risk factors has the potential to reduce CVD incidence...
July 18, 2016: European Journal of Preventive Cardiology
Jude S Morton, Christy-Lynn Cooke, Sandra T Davidge
The developmental origins of health and disease theory is based on evidence that a suboptimal environment during fetal and neonatal development can significantly impact the evolution of adult-onset disease. Abundant evidence exists that a compromised prenatal (and early postnatal) environment leads to an increased risk of hypertension later in life. Hypertension is a silent, chronic, and progressive disease defined by elevated blood pressure (>140/90 mmHg) and is strongly correlated with cardiovascular morbidity/mortality...
April 2016: Physiological Reviews
Gerbrand A Zoet, Maria P H Koster, Birgitta K Velthuis, Christianne J M de Groot, Angela H E M Maas, Bart C J M Fauser, Arie Franx, Bas B van Rijn
Women who develop preeclampsia have an increased risk of cardiovascular disease (CVD) later in life. However, current guidelines on cardiovascular risk assessment and prevention are unclear on how and when to screen these women postpartum, and about the role of a positive history of preeclampsia in later-life CVD risk management. The aim of this review is to discuss the present knowledge on commonly used cardiovascular screening modalities available to women with a history of preeclampsia, and to discuss recent developments in early detection of CVD using cardiovascular imaging...
October 2015: Maturitas
Michael John Paidas, Johan Frieling, Joost de Jongh, Henk-Jan Drenth, James Streisand
INTRODUCTION: Acquired antithrombin deficiency is one of the distinguishing features of early-onset preeclampsia, the leading cause of maternal and perinatal morbidity and mortality. Antithrombin's pleiotropic effects suggest it may slow the progression of early-onset preeclampsia and extend pregnancy in patients being managed expectantly. Prior human studies demonstrate that maternal administration of antithrombin prolongs expectant management, but the source of antithrombin, human plasma, limits its use for early-onset preeclampsia...
May 2015: Obstetrics and Gynecology
Dania A Shah, Raouf A Khalil
Preeclampsia is a pregnancy-associated disorder characterized by hypertension, and could lead to maternal and fetal morbidity and mortality; however, the pathophysiological mechanisms involved are unclear. Predisposing demographic, genetic and environmental risk factors could cause localized abnormalities in uteroplacental cytoactive factors such as integrins, matrix metalloproteinases, cytokines and major histocompatibility complex molecules leading to decreased vascular remodeling, uteroplacental vasoconstriction, trophoblast cells apoptosis, and abnormal development of the placenta...
June 15, 2015: Biochemical Pharmacology
S Findeklee, S D Costa, S N Tchaikovski
Thrombophilia is a prothrombotic state that can be caused by genetic disorders, such as the factor-V-Leiden or prothrombin mutation, as well as by acquired changes like oestrogen-induced APC resistance and the antiphospholipid syndrome. Pregnancy induces multiple procoagulant changes in the haemostatic system, increasing the risk of venous thromboembolism in women with a thrombophilia even further. Additionally, thrombophilias are suggested to be associated with a number of pregnancy complications such as recurrent miscarriage, stillbirth, preeclampsia and HELLP syndrome...
February 2015: Zeitschrift Für Geburtshilfe und Neonatologie
Yolande Appelman, Bas B van Rijn, Monique E Ten Haaf, Eric Boersma, Sanne A E Peters
Cardiovascular disease (CVD) has been seen as a men's disease for decades, however it is more common in women than in men. It is generally assumed in medicine that the effects of the major risk factors (RF) on CVD outcomes are the same in women as in men. Recent evidence has emerged that recognizes new, potentially independent, CVD RF exclusive to women. In particular, common disorders of pregnancy, such as gestational hypertension and diabetes, as well as frequently occurring endocrine disorders in women of reproductive age (e...
July 2015: Atherosclerosis
Gene L Bidwell, Eric M George
The last several decades have seen intensive research into the molecular mechanisms underlying the symptoms of preeclampsia. While the underlying cause of preeclampsia is believed to be defective placental development and resulting placental ischemia, it is only recently that the links between the ischemic placenta and maternal symptomatic manifestation have been elucidated. Several different pathways have been implicated in the development of the disorder; most notably production of the anti-angiogenic protein sFlt-1, induction of auto-immunity and inflammation, and production of reactive oxygen species...
2014: Frontiers in Pharmacology
Ecaterina Berzan, Ross Doyle, Catherine M Brown
Hypertension is the most common medical disorder encountered during pregnancy, occurring in about 6-8 % of pregnancies. Preeclampsia is a pregnancy-specific disorder that occurs after 20 weeks' gestation, characterized by hypertension and proteinuria. Preeclampsia can also occur superimposed upon chronic hypertension. Eclampsia is the convulsive form of preeclampsia, and affects 0.1 % of all pregnancies. In low-income and middle-income countries, preeclampsia and eclampsia are associated with 10-15 % of direct maternal deaths...
September 2014: Current Hypertension Reports
Leslie Myatt, Christopher W Redman, Anne Cathrine Staff, Stefan Hansson, Melissa L Wilson, Hannele Laivuori, Lucilla Poston, James M Roberts
Preeclampsia remains a major problem worldwide for mothers and babies. Despite intensive study, we have not been able to improve the management or early recognition of preeclampsia. At least part of this is because of failure to standardize the approach to studying this complex syndrome. It is possible that within the syndrome there may be different phenotypes with pathogenic pathways that differ between the subtypes. The capacity to recognize and to exploit different subtypes is of obvious importance for prediction, prevention, and treatment...
June 2014: Hypertension
Tess Marchetti, Marie Cohen, Jean-Christophe Gris, Philippe de Moerloose
Obstetrical antiphospholipid syndrome (APS) is defined by obstetrical complications and the presence of antiphospholipid antibodies (aPL). Although the incidence of APS is still poorly known, this thrombophilia is now recognized as one of the most common acquired causes of recurrent fetal loss. The diagnosis of APS during pregnancy can be challenging because of its various clinical features. Mothers with APS have an increased risk of thrombosis, thrombopenia, and specific pregnancy‑related complications such as preeclampsia, eclampsia, and hemolysis elevated liver enzyme and low‑platelet syndrome...
2013: Polskie Archiwum Medycyny Wewnętrznej
Shunji Suzuki, Manabu Shimada, Yoshie Shibata-Hiraizumi
OBJECTIVE: This study was to examine the clinical usefulness of expectant management of early-onset severe preeclampsia. METHODS: We reviewed the obstetric records of all Japanese singleton deliveries at ≥22 weeks' gestation managed at Japanese Red Cross Katsushika Maternity Hospital between 2007 and 2012. We compared the obstetric characteristics and perinatal outcomes between the cases of deliveries before (n = 19) and after completion of corticosteroids (n = 30) (immediate delivery versus expectant management)...
October 2014: Journal of Maternal-fetal & Neonatal Medicine
Lucy C Chappell, Suzy Duckworth, Paul T Seed, Melanie Griffin, Jenny Myers, Lucy Mackillop, Nigel Simpson, Jason Waugh, Dilly Anumba, Louise C Kenny, Christopher W G Redman, Andrew H Shennan
BACKGROUND: Hypertensive disorders of pregnancy are a major contributor to death and disability for pregnant women and their infants. The diagnosis of preeclampsia by using blood pressure and proteinuria is of limited use because they are tertiary, downstream features of the disease. Placental growth factor (PlGF) is an angiogenic factor, a secondary marker of associated placental dysfunction in preeclampsia, with known low plasma concentrations in the disease. METHODS AND RESULTS: In a prospective multicenter study, we studied the diagnostic accuracy of low plasma PlGF concentration (<5th centile for gestation, Alere Triage assay) in women presenting with suspected preeclampsia between 20 and 35 weeks' gestation (and up to 41 weeks' gestation as a secondary analysis)...
November 5, 2013: Circulation
T Girard, S Brugger, I Hösli
BACKGROUND: The risk profile of patients in obstetric anesthesia has substantially changed. Even more so than other disciplines, obstetric anesthesia is therefore in the true sense of the word dependent on the close coordination of all concerned and a good interdisciplinary cooperation. AIM: This article explains the important anesthesiological risks connected with parturition and presents the corresponding concepts for prevention, diagnosis and management of peripartum complications...
December 2013: Der Anaesthesist
Anjali Acharya, Jolina Santos, Brian Linde, Kisra Anis
Pregnancy-related acute kidney injury (PR-AKI) causes significant maternal and fetal morbidity and mortality. Management of PR-AKI warrants a thorough understanding of the physiologic adaptations in the kidney and the urinary tract. Categorization of etiologies of PR-AKI is similar to that of acute kidney injury (AKI) in the nonpregnant population. The causes differ between developed and developing countries, with thrombotic microangiopathies (TMAs) being common in the former and septic abortion and puerperal sepsis in the latter...
May 2013: Advances in Chronic Kidney Disease
Eric M George, Ana C Palei, Edward A Dent, Joey P Granger
Preeclampsia is a complication of pregnancy that is marked by hypertension, proteinuria, and maternal endothelial dysfunction. A central factor in the etiology of the disease is the development of placental hypoxia/ischemia, which releases pathogenic soluble factors. There is currently no effective treatment for preeclampsia, but the phosphodiesterase-5 (PDE-5) inhibitor sildenafil has been suggested, as PDE-5 is enriched in the uterus, and its antagonism could improve uteroplacental function. Here, we report in the reduced uterine perfusion pressure (RUPP) rat model that administration of oral sildenafil is effective in attenuating placental ischemia-induced hypertension during gestation...
August 15, 2013: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Nandini Hadker, Suchita Garg, Cory Costanzo, Wim van der Helm, James Creeden
OBJECTIVE: To quantify the financial impact of adding a novel serum test to the current diagnostic toolkit for preeclampsia (PE) detection in Germany. METHODS: A decision-analytic model was created to quantify the economic impact of adding a recently developed novel diagnostic test for PE (Roche Diagnostics, Rotkreuz, Switzerland) to current diagnostic practice in Germany. The model simulated a cohort of 1000 pregnant patients receiving obstetric care and quantified the budget impact of adding the novel test to current German PE detection and management practices...
May 2013: Hypertension in Pregnancy
T A Jido, I A Yakasai
Preeclampsia is a common complication of pregnancy associated with high maternal and perinatal morbidity and mortality especially in developing countries. There is considerable progress in the understanding of the pathophysiology and the management of the diseases, although the aetiology and primary pathology remained elusive. Integration of current evidence in the clinical management of the condition has witnessed improved maternal and fetal outcomes in many societies. In developing countries variations in management often not based on current evidence accounts for comparatively higher morbidity and mortality...
April 2013: Annals of African Medicine
May-Britt Heidrich, Daniela Wenzel, Constantin S von Kaisenberg, Cordula Schippert, Frauke M von Versen-Höynck
BACKGROUND: Preeclampsia (PE), a hypertensive disorder of pregnancy affects 2-8% of women and is associated with increased cardiovascular disease (CVD) risk later in life. There is little information about the knowledge of obstetrician-gynecologists in German outpatient care setting regarding the future health risk of PE and knowledge of the current guidelines on treatment and counseling patients post PE. This study aimed to assess whether obstetrician-gynecologists are aware of PE's association with maternal long-term adverse outcomes and providing appropriate counseling...
2013: BMC Pregnancy and Childbirth
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