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Pre-eclampsiaPre-eclampsia - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Pre-eclampsia Last reviewed: February 2019 Last updated: August 2018 Summary Hypertensive syndrome that occurs in pregnant women after 20 weeks' gestation, consisting of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement. All pregnant women presenting with hypertension and either proteinuria (...) or evidence of systemic involvement require close assessment and monitoring for pre-eclampsia and its complications. Delivery is the definitive treatment; the decision about when and how to deliver should only be made after a thorough assessment of the risk and benefits to the mother and baby. Other mainstays of management include antihypertensive therapy, seizure control, and fluid restriction. Maternal mortality is highest after delivery, so vigilance should be maintained in the postpartum period. Can
Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin in prevention of preterm preeclampsia in subgroups of women according to their characteristics and medical and obstetrical history The Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial demonstrated that in women who were at high risk for preterm preeclampsia with delivery at <37 weeks' gestation identified by screening by means of an algorithm (...) that combines maternal factors and biomarkers at 11-13 weeks' gestation, aspirin administration from 11 to 14 until 36 weeks' gestation was associated with a significant reduction in the incidence of preterm preeclampsia (odds ratio 0.38; 95% confidence interval, 0.20 to 0.74; P=0.004).We sought to examine whether there are differences in the effect of aspirin on the incidence of preterm preeclampsia in the Aspirin for Evidence-Based Preeclampsia Prevention trial in subgroups defined according to maternal
Epidural therapy for the treatment of severe pre-eclampsia in non labouring women. Pre-eclampsia is a pregnancy-specific multi-organ disorder, which is characterised by hypertension and multisystem organ involvement and which has significant maternal and fetal morbidity and mortality. Failure of the placental vascular remodelling and reduced uteroplacental flow form the etiopathological basis of pre-eclampsia. There are several established therapies for pre-eclampsia including antihypertensives (...) and anticonvulsants. Most of these therapies aim at controlling the blood pressure or preventing complications of elevated blood pressure, or both. Epidural therapy aims at blocking the vasomotor tone of the arteries, thereby increasing uteroplacental blood flow. This review was aimed at evaluating the available evidence about the possible benefits and risks of epidural therapy in the management of severe pre-eclampsia, to define the current evidence level of this therapy, and to determine what (if any) further
Planned caesarean section versus planned vaginal birth for severe pre-eclampsia. Pre-eclampsia is a very frequent complication of pregnancy, and anticipation of birth is often necessary. However, the best mode of giving birth remains to be established, although observational studies suggest better maternal and perinatal outcomes with vaginal birth.To assess the effects of a policy of planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia on mortality (...) and morbidity for mother and baby.We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (6 September 2017) and reference lists of retrieved studies.We planned to include all randomised trials of planned caesarean section versus planned vaginal birth for pregnant women with severe pre-eclampsia. Quasi-randomised and non-randomised studies are not eligible for inclusion in this review.The
Association between insulin resistance and preeclampsia in obese non-diabetic women receiving metformin To examine whether the reduced incidence of preeclampsia in non-diabetic obese pregnant women treated with metformin is mediated by changes in insulin resistance.This was a secondary analysis of obese pregnant women in a randomised trial (MOP trial). Fasting plasma glucose and insulin were measured in 384 of the 400 women who participated in the MOP trial. Homeostasis model assessment (...) of insulin resistance (HOMA-IR) was compared in the metformin and placebo groups and in those that developed preeclampsia versus those that did not develop preeclampsia.At 28 weeks, median HOMA-IR was significantly lower in the metformin group. Logistic regression analysis demonstrated that there was a significant contribution in the prediction of preeclampsia from maternal history of chronic hypertension and gestational weight gain, but not HOMA-IR either at randomisation (p = 0.514) or at 28 weeks (p
MicroRNAs: New Players in the Pathobiology of Preeclampsia Our understanding of how microRNAs (miRNAs) regulate gene networks and affect different molecular pathways leading to various human pathologies has significantly improved over the years. In contrary, the role of miRNAs in pregnancy-related hypertensive disorders such as preeclampsia (PE) is only beginning to emerge. Recent papers highlight that adverse pregnancy outcomes are associated with aberrant expression of several miRNAs
The Impact of Silymarin on Improvement of Hepatic Abnormalities in Patients with Severe Preeclampsia: A Randomized Clinical Trial Preeclampsia is a pregnancy-specific disorder, associated with increased blood pressure and proteinuria, and in extreme cases it can also cause liver and kidney problems.To determine the impact of silymarin on the improvement of severe preeclampsia.This randomized clinical trial was conducted at Hajar Hospital in Shahrekord, Iran, from April 2014 to September 2015 (...) . Sixty patients whose pregnancy had ended as a result of severe preeclampsia, were entered into the study. Patients were randomly divided into two groups of thirty study and control groups. In addition to current treatment for preeclampsia, case groups were administered 70 mg of silymarin, three and twenty four hours after the termination of pregnancy. The control group received placebo at the same time. The blood pressure and AST, ALT, ALP, LDH, uric acid, bilirubin and kidney tests were compared
Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. Preterm preeclampsia is an important cause of maternal and perinatal death and complications. It is uncertain whether the intake of low-dose aspirin during pregnancy reduces the risk of preterm preeclampsia.In this multicenter, double-blind, placebo-controlled trial, we randomly assigned 1776 women with singleton pregnancies who were at high risk for preterm preeclampsia to receive aspirin, at a dose of 150 mg per day (...) , or placebo from 11 to 14 weeks of gestation until 36 weeks of gestation. The primary outcome was delivery with preeclampsia before 37 weeks of gestation. The analysis was performed according to the intention-to-treat principle.A total of 152 women withdrew consent during the trial, and 4 were lost to follow up, which left 798 participants in the aspirin group and 822 in the placebo group. Preterm preeclampsia occurred in 13 participants (1.6%) in the aspirin group, as compared with 35 (4.3
Frontal lobe meningioma mimicking preeclampsia: A case study We report a case of a left frontal lobe meningioma presenting in a woman with proteinuric preeclampsia in her first term pregnancy. The patient had a background of antepartum migraines that resolved in the second trimester of pregnancy. Postpartum, she required urgent surgery and sustained convulsions after surgery. She had no residual disease and has had another successful pregnancy. This case highlights the importance of cerebral (...) imaging in the context of an atypical clinical course of preeclampsia. Although headaches are common in pregnancy and usually benign, other, more serious, diagnoses should be considered with atypical headaches, a change in the nature of the headache, and headaches that persist despite appropriate treatment. A full neurological examination including fundoscopy to exclude papilloedema should be performed and abnormal findings require further investigation.
Screening for Preeclampsia: US Preventive Services Task Force Recommendation Statement. Preeclampsia affects approximately 4% of pregnancies in the United States. It is the second leading cause of maternal mortality worldwide and may lead to serious maternal complications, including stroke, eclampsia, and organ failure. Adverse perinatal outcomes for the fetus and newborn include intrauterine growth restriction, low birth weight, and stillbirth. Many of the complications associated (...) with preeclampsia lead to early induction of labor or cesarean delivery and subsequent preterm birth.Preeclampsia is more prevalent among African American women than among white women. Differences in prevalence may be, in part, due to African American women being disproportionally affected by risk factors for preeclampsia. African American women also have case fatality rates related to preeclampsia 3 times higher than rates among white women. Inequalities in access to adequate prenatal care may contribute
of Risk All pregnant women are at risk for preeclampsia and should be screened. Important clinical conditions associated with increased risk for preeclampsia include a history of eclampsia or preeclampsia (particularly early-onset preeclampsia), a previous adverse pregnancy outcome, maternal comorbid conditions (including type 1 or 2 diabetes prior to pregnancy, gestational diabetes, chronic hypertension, renal disease, and autoimmune diseases), and multifetal gestation. Other risk factors include (...) mortality, morbidity from eclampsia, HELLP (hemolysis, elevated liver enzyme levels, low platelet counts) syndrome, organ damage or failure, fetal growth restriction, preterm delivery, low birth weight, stillbirth, and placental abruption. Evidence was sought on the screening test performance of clinical blood pressure measurement, urinalysis, or both for identifying women with preeclampsia at the time of screening (KQ4), to compare the effectiveness of different screening protocols (e.g., instruments
Advocacy is essential to supporting women with pre-eclampsia Advocacy has a critical role in advancing the maternal health agenda. Patient advocacy groups can hold governments and other stakeholders accountable and ensure that commitments are translated into concrete action. This article highlights the advocacy efforts of the Preeclampsia Foundation, a patient advocacy organisation that aims to improve the diagnosis, management, and prevention of pre-eclampsia through research and improved
Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid (...) to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis Frampton G K, Jones J, Rose M & Payne L Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Frampton G K, Jones J, Rose M & Payne L. Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women
. Myatt L, Roberts JM. Preeclampsia: syndrome or disease? Curr Hypertens Rep . 2015;17(11):83. 3. Redman C. Pre-eclampsia: a complex and variable disease. Pregnancy Hypertens . 2014;4(3):241-2. 4. Henderson JT, Thompson JH, Burda BU, Cantor A, Beil T, Whitlock EP. Screening for Preeclampsia: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 148. AHRQ Publication No. 14-05211-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2017. 5 (...) . 2005;111(5):697-716. 16. Meads CA, Cnossen JS, Meher S, et al. Methods of prediction and prevention of pre-eclampsia: systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technol Assess . 2008;12(6):iii-iv, 1-270. 17. Siddique J, Lantos JD, VanderWeele TJ, Lauderdale DS. Screening tests during prenatal care: does practice follow the evidence? Matern Child Health J . 2012;16(1):51-9. 18. U.S. Preventive Services Task Force. Screening for preeclampsia. In: Guide
The Relationship Between Blood Lead Level and Preeclampsia Lead is a heavy metal to which people are commonly exposed. One of the possible mechanisms of tissue damages caused by this toxic metal is oxidative stress, which in turn may cause numerous pregnancy complications such as preeclampsia. The present study was conducted to determine the relationship between maternal Blood Lead Level (BLL) and preeclampsia.The present case-control study was conducted on 158 pregnant women admitted (...) in the control group and 8.04±3.4 μg/dl in the preeclampsia group. The two groups were matching in terms of the mother's age and education and the household income. A significant relationship was observed between BLL and preeclampsia (p=0.028), as per every unit of increase (1 μg/dl) in BLL, systolic blood pressure increased by 0.014 mm Hg and diastolic blood pressure by 0.013 mm Hg (p=0.004).The results obtained suggest a relationship between BLL and preeclampsia. Global health measures should be taken
The evaluation of serum homocysteine, folic acid, and vitamin B12 in patients complicated with preeclampsia Increased plasma homocysteine may be associated with adverse pregnancy outcomes, such as preeclampsia. The aim of this study was to determine the plasma homocysteine, serum folate, and vitamin B12 levels in preeclamptic pregnant women.This case-control study was conducted in 2016 in Ahwaz on 51 pregnant women with preeclampsia and 51 healthy pregnant women of the same gestational age, who (...) served as controls. The case group also was subdivided into severe and non-severe preeclampsia. Patients' data were collected through a questionnaire and medical records. Serum homocysteine, folic acid, and vitamin B12 were analyzed using chemiluminescent assay. The results were compared between two groups. Statistical analyses were done using IBM-SPSS 20.0. A Kolmogorov-Smirnov test, independent samples t-test, Mann-Whitney test, and Chi-square test were used for data analysis.No different
to an intervention group (who received a pamphlet) or a control group (who did not received a pamphlet). The pamphlet and questionnaire, both designed by a multidisciplinary team, were read and answered at the same time.Baseline and demographic characteristics were similar between the two groups. Knowledge about the symptoms of pre-eclampsia was excellent in both groups (61% to 100% correct answers). Women in both groups were well aware that preeclampsia in the past (P = 0.22) and a family history (...) The impact of an educational pamphlet on knowledge and anxiety in women with preeclampsia. This study was undertaken to evaluate whether or not an educational pamphlet could improve knowledge without increasing anxiety in women with preeclampsia.One hundred women recruited from an inpatient setting with suspected or proven preeclampsia were asked to answer a questionnaire assessing demographics, knowledge (primary outcome), anxiety and satisfaction (secondary outcomes) after being randomized
Soluble fms-Like Tyrosine Kinase-1-to-Placental Growth Factor Ratio and Time to Delivery in Women With Suspected Preeclampsia To assess the association of a serum soluble fms-like tyrosine kinase 1-to-placental growth factor (sFlt-1-to-PlGF) ratio of greater than 38 with time to delivery and preterm birth.Secondary analysis of an observational cohort study that included women 18 years of age or older from 24 to 36 6/7 weeks of gestation at their first study visit with suspected (not confirmed (...) ) preeclampsia. Participants were recruited from December 2010 to January 2014 at 30 sites in 14 countries. A total of 1,041 women were included in time-to-delivery analysis and 848 in preterm birth analysis.Women with an sFlt-1-to-PlGF ratio greater than 38 (n=250) had a 2.9-fold greater likelihood of imminent delivery (ie, delivery on the day of the test) (Cox regression hazard ratio 2.9; P<.001) and shorter remaining time to delivery (median 17 [interquartile range 10-26] compared with 51 [interquartile
Perinatal and Hemodynamic Evaluation of Sildenafil Citrate for Preeclampsia Treatment: A Randomized Controlled Trial To evaluate whether therapy with sildenafil citrate prolongs gestation in women with preeclampsia.In a randomized double-blind, placebo-controlled trial, 100 singleton pregnancies with preeclampsia between 24 and 33 weeks of gestation were randomized to 50 mg oral sildenafil citrate every 8 hours or placebo. The primary outcome was prolongation of pregnancy from randomization
The impact of Silymarin on improvement of platelet abnormalities in patients with severe preeclampsia. Preeclampsia is a pregnancy-specific disorder that is associated with an increase in blood pressure and proteinuria; in severe cases, it can cause platelet abnormalities. Silymarin is the extract of Silybum marianum, which is recognized as a safe antioxidant drug.To determine the impact of Silymarin on the improvement of severe preeclampsia in 60 patients with severe preeclampsia.In (...) this double-blind clinical trial study, This study included 60 patients whose pregnancies were terminated because of severe preeclampsia and who were referred to Hajar Hospital in Shahrekord, Iran, from April 2014 to September 2015. The patients were divided randomly into two groups, i.e., a group of 30 patients and a control group of 30 patients. In addition to the current treatments for preeclampsia, The members of the study group were administered 70 mg of Silymarin at three hours and 24 hours after