Prediction of Preeclampsia-Bench to Bedside

Abstract

Hypertensive disorders of pregnancy (HDP) constitute the most common medical condition seen during gestation, effecting 1 in 10 pregnancies in the USA. Traditionally, preeclampsia (PE) is defined as a new onset of hypertension and either proteinuria or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman. Preeclampsia is a potentially life-threatening condition with widespread underlying endothelial dysfunction, and accompanying inflammation, vasoconstriction, and platelet activation. Women with preeclampsia are at an increased risk for life-threatening complications and progression to eclampsia. Worldwide, 10 to 15 % of maternal deaths are from preeclampsia and related complications. Traditionally, diagnosis of preeclampsia is made based upon presence of risk factors and clinical criteria. Diagnosis is challenging in asymptomatic women early in pregnancy as well as in nulliparous women as they lack obstetric history; however, it is well known that women with previous preeclampsia have a 14.7 % risk of the condition in the second pregnancy. Prediction of those at risk and early diagnosis is crucial to enable close surveillance of high-risk women in order to improve maternal and fetal outcomes. There has been much advance in our understanding of the pathogenesis of PE and in the field of angiogenic markers. However, no one test meets the criteria for a good biomarker. A multiparametric approach appears to be optimal as we await newer systems biology approaches to give us better insight into the pathogenesis of the disease.

Prevalence of pregnancy hypertensive disorders in Mongolia

“…4,5,6 The diagnostic criteria were hypertension new to pregnancy after twenty weeks defined as a systolic blood pressure ≥ 140 mmhg or diastolic blood pressure ≥ 90 mmhg observed twice at least 4 hours apart, or blood pressure at any time over 160/110, and proteinuria defined as ≥ 300 mg/24 hour urine collection or protein creatinine ratio ≥ 0.3 and a dipstick reading > +1. In the absence of proteinuria, the diagnosis was made with hypertension as above and a new onset of any of the following: renal insufficiency (serum creatinine concentration > 90 µmol/L), impaired liver function (elevated liver transaminases measured at twice the normal concentration), thrombocytopenia (platelet count < 100,000/µL), pulmonary edema, or cerebral or visual symptoms.…”

Systematic review supports the role of DNA methylation in the pathophysiology of preeclampsia: a call for analytical and methodological standardization

“…Fine-tuning sensitive mechanisms such as angiogenesis and the fetal-maternal interface and adequate cytotrophoblast invasion with the remodeling of the spiral arteries are crucial for physiological placentation. Adverse pregnancy outcomes, such as preeclampsia, could be the results of these processes [91]. In an effort to improve reporting standards in studies of human placenta, the use of a consistent sampling location and focusing on a specific cell type have been recommended [84].…”

The Role of Predictor Placental Growth Factor, Soluble Endoglin, Soluble-FMS-Like-Tyrosine Kinase-1 and Pulsatil Uterina Arterial Index to Predict the Early Onset of Preeclampsia

“…Soluble endoglin or abbreviated as the task of binding TGFB1 and TGFB2. It is an antiangiogenic factor that plays a role in inhibiting TGFB1 binding to its receptors, resulting in a disruption in the production of nitric oxide (NO), vasodilation, and capillary formation by endothelial cells in vitro [20].…”