Preeclampsia in 2018: Revisiting Concepts, Physiopathology, and Prediction

Abstract

Preeclampsia currently remains one of the leading causes of death and severe maternal morbidity. Although its prevalence is still underestimated in some places due to underreporting, preeclampsia is a disease that health professionals need to know how to deal with and take action. For this reason, the studies about the theme remain along with the advances in their understanding that often implies improvement and change of concepts and conducts. The complexity of its etiology is a challenge and requires further studies for its full understanding. Apparently, poor adaptation of the maternal organism to the conceptus, marked by the nonoccurrence of changes in the uterine spiral arteries, determines a series of systemic repercussions that compound the various forms of preeclampsia presentation. In recent years, the use of acetylsalicylic acid to prevent cases of early onset of the disease has been consolidated and, alongside, studies have advanced the development of accessible and effective methods of identifying women at risk of preeclampsia. The aim of this review is to discuss updates on the occurrence, concept, pathophysiology, repercussion, prevention, and prediction of preeclampsia.

Immune and Apoptosis Mechanisms Regulating Placental Development and Vascularization in Preeclampsia

“…The pathogenesis of preeclampsia is still not well-understood and seems to associate differential complex alterations in the placenta and maternal circulation, turning this disorder a major subject of a large amount of studies. Some, however, agree that the preeclampsia origin is an abnormal placentation, which can be defined by two distinct developmental stages: the pre-clinical and the clinical stages (Mayrink et al, 2018). While the pre-clinical stage is determined by critical changes in placental structure and development, the clinical stage is characterized by circulatory systemic changes and symptoms in the mother.…”

“…A disrupted remodeling of maternal spiral arteries is, therefore, a major consequence of the pre-clinical stage. It further contributes to promote placental ischemia and to stimulate the secretion of pro-inflammatory factors by the placenta, leading to the second stage of abnormal placentation (Mayrink et al, 2018). Following the pre-clinical stage, the clinical stage corresponds to the manifestation of symptoms in the mother such as severe, and sometimes uncontrolled, high blood pressure, and proteinuria followed by the dysfunction of multiple organs (Chaiworapongsa et al, 2014).…”

Use of antimalarial drugs is associated with a lower risk of preeclampsia in lupus pregnancy: A prospective cohort study

“…[6][7][8][9][10][11][12][13] The importance of preeclampsia consists of the fact that it is a complication associated with high maternal and fetal morbidity and mortality, mainly in developing countries. 14 In addition, an increased risk of future cardiovascular complications in both newborns and women complicated with preeclampsia has been reported. 15,16 In women with SLE, several risk factors for developing preeclampsia have been described.…”

From first‐trimester screening to risk stratification of evolving pre‐eclampsia in second and third trimesters of pregnancy: comprehensive approach

“…Pre-eclampsia is defined as early-onset when it leads to delivery < 34 weeks of gestation and late-onset when it occurs ≥ 34 weeks of gestation. It is also subclassified as preterm or term, depending on whether the onset occurs < 37 weeks or ≥ 37 weeks of gestation, respectively 9 . Subclassification of pre-eclampsia is particularly important as early-onset pre-eclampsia is more likely than term pre-eclampsia to be associated with placental insufficiency, with potentially quite different clinical manifestations 10 .…”