From the Research
Introduction to Preeclampsia
Preeclampsia is a complex and multifactorial disorder of pregnancy, characterized by the onset of hypertension and often accompanied by proteinuria and other systemic manifestations [ 1, 2, 3, 4, 5 ]. It is a major cause of maternal and perinatal morbidity and mortality worldwide.
Pathophysiology
The pathophysiology of preeclampsia involves abnormal placentation, leading to the release of antiangiogenic factors, such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), which cause endothelial dysfunction, vasoconstriction, and immune dysregulation [ 2, 4 ]. This results in a maternal inflammatory response, characterized by hypertension, proteinuria, and other systemic signs.
Clinical Presentation
The clinical presentation of preeclampsia is highly variable, but common features include:
- Hypertension
- Proteinuria
- Systemic organ dysfunction, such as renal, hepatic, and cerebral involvement
- Placental insufficiency, leading to fetal growth restriction and other adverse pregnancy outcomes [ 1, 2, 3, 4, 5 ]
Diagnosis and Treatment
The diagnosis of preeclampsia is based on the presence of hypertension and proteinuria, although the diagnostic criteria are not well established [ 1 ]. Treatment options are limited, and delivery is the only definitive cure [ 1, 3, 4 ]. For women with mild preeclampsia, expectant management may be indicated to improve fetal maturity, often requiring maternal medical treatment [ 3 ]. Low-dose aspirin is recommended for prophylaxis in high-risk populations [ 4 ].
Differentials and Caveats
It is essential to consider other potential causes of hypertension and proteinuria in pregnancy, such as:
- Chronic hypertension
- Renal disease
- Liver disease
- Other systemic disorders [ 2, 5 ] Additionally, preeclampsia can have long-term consequences for both the mother and the neonate, including increased cardiovascular risk in later life [ 3 ].
Management and Prevention
Management of preeclampsia involves timely diagnosis, proper management, and timely delivery [ 1 ]. Prevention strategies, such as low-dose aspirin, may be effective in high-risk populations [ 4 ]. Further research is needed to clarify the pathophysiology of preeclampsia and to identify potential therapeutic targets for improved treatment and outcomes [ 4, 5 ].