The Diversity of Diagnoses of Preeclampsia

Harlow, Francoise; Brown, Mark

doi:10.1081/prg-100104172

Cited by 14 publications

(10 citation statements)

References 22 publications

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“…Possible differences are that in the PIERS study pre-eclampsia was considered in the absence of proteinuria, if hypertension and hyperuricemia or HELLP syndrome were present. Indeed it is likely that the heterogeneity amongst these and many previous studies is a facet of the different diagnostic criteria employed in the definition of pre-eclampsia, which originates from incomplete comprehension of its pathophysiology and likely diverse aetiology[24]. Nevertheless in the PIERS study an increased odds of adverse outcomes was observed when 3 to 4+ dipstick proteinuria was detected [17].…”

Section: Discussionmentioning

confidence: 99%

Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women

et al. 2013

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ObjectivesTo evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ≥500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension.DesignSecondary analysis of the Vitamins in Pre-Eclampsia Trial.Setting25 UK hospitals in ten geographical areas.Population946 women with pre-existing risk factors for pre-eclampsia.MethodsWomen with pre-eclampsia and proteinuria 300-499mg/24h (PE300, referent group, n=60) or proteinuria ≥500 mg/24h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110).Main Outcome MeasuresMaternal: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5th centile, gestation at delivery.ResultsSevere hypertension occurred more frequently in PE500 (35%) and PE300 (27%) than CHT (5.9%; P≤0.01) and GH (10%; p≤0.001). Gestation at delivery was earlier in PE500 (33.2w) than PE300 (37.3w; P≤0.001), and later in CHT (38.3w; P≤0.05) and GH (39.1w; P≤0.001). SGA infants were more frequent in PE300 (32%) than in CHT (13.3%; P≤0.001) and GH (16.5%; P≤0.05). Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P≤0.001), and to receive magnesium sulphate (17% vs. 1.7%, P≤0.05).ConclusionWomen with PE300 have complication rates above those of women managed as out-patients (GH and CHT), meriting closer surveillance and confirming 300 mg/d as an appropriate threshold for determining in-patient management. Adverse perinatal outcomes are higher still in women with PE500.

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Section: Discussionmentioning

confidence: 99%

Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women

et al. 2013

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“…The definition of pre-eclampsia may vary between studies. 12 We used the definition of pre-eclampsia in Norway (blood pressure >140/90 mmHg and proteinuria; ‡ 1+ on dipstick) and thereby also in the Medical Birth Registry of Norway. This definition is widely accepted.…”

Section: Discussionmentioning

confidence: 99%

“…The placenta is weighed immediately after delivery, fresh with membranes and umbilical cord attached. Using all placentas, z-scores of placental weight were calculated according to placental weight for gestational age and offspring sex, 12 and divided into ten categories (deciles) with equal numbers in each, with category one as the smallest and category ten as the largest placentas.…”

Section: Methodsmentioning

confidence: 99%

Do pregnancies with pre‐eclampsia have smaller placentas? A population study of 317 688 pregnancies with and without growth restriction in the offspring

Eskild

Vatten

2010

BJOG

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“…The threshold for abnormal protein excretion is increased to 300 mg per day, or 30 mg/mmol creatinine. 19 This threshold is an all or none categorization of renal involvement as there has been no evidence that the foetal or maternal outcomes are directly related to the degree of proteinuria. In everyday clinical practice the spot test has the ease of collection but requires local validation; in some centres the protein creatinine ratio is still questioned in terms of reliability.…”

Section: Renal Involvement In Preeclampsiamentioning

confidence: 99%

“…Much work has been done to validate a spot urine test of protein : creatinine ratio to establish a firm diagnosis of proteinuria 18 compared with the clinical ‘gold standard’ of a 24 h urine collection for protein assessment. The threshold for abnormal protein excretion is increased to 300 mg per day, or 30 mg/mmol creatinine 19 . This threshold is an all or none categorization of renal involvement as there has been no evidence that the foetal or maternal outcomes are directly related to the degree of proteinuria.…”

Section: Renal Involvement In Preeclampsiamentioning

confidence: 99%

Preeclamptic nephropathy

Hennessy

Makris

2011

Nephrology

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This paper by Hennessy and Makris describes the renal changes in pregnancy and preeclampsia, from the clinical presentation in relation to underlying pathophysiology. The paper describes the classic renal syndromes, changes in GFR and proteinuria, RAAS, new molecular mechanisms (including anti-angiogenic proteins), AT1 autoAb and histopathological findings. The authors then discuss the importance of the future impact of preeclampsia on long-term health, and strategies for management. ABSTRACT:With the recent discovery of potential serum 'toxins' in human preeclampsia, it is timely to consider how these might relate to preeclamptic nephropathy. This review will discuss the clinical presentation of preeclampsia with an emphasis on renal involvement. It will explore the nature of the renal histological changes including endothelial and the more recently discovered podocyte changes, the implications of elevated anti-angiogenic molecules, anti-angiotensin-1 receptor agonistic antibodies and other proposed mechanisms in causing or exacerbating renal lesions. It will also explore the role of pre-existing renal disease in causing preeclampsia and the potential for new biomarkers, both serum and urinary, to inform clinical practice with regard to differentiating preeclampsia from pre-existing renal disease. Recommendations about the future of women who have had preeclampsia are unclear but the general consensus is that there are future cardiovascular risks, and to a lesser extent, future renal risks in these women. Regular review of proteinuria and glomerular filtration rate as well as overall cardiovascular risk status seems a logical step.

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The Diversity of Diagnoses of Preeclampsia

Cited by 14 publications

References 22 publications

Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women

Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women

Do pregnancies with pre‐eclampsia have smaller placentas? A population study of 317 688 pregnancies with and without growth restriction in the offspring

Preeclamptic nephropathy

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