Preeclampsia

Preeclampsia is a systemic disease of pregnancy: it currently affects approximately 7.5% of pregnancies globally and is increasing in incidence. Although the precise aetiology is unknown, the disease is characterised by a widespread endothelial dysfunction associated with the down-regulation of proangiogenic factors (e.g., soluble Flt-1 [SFlt-1] and soluble endoglin [sEng]). Numerous clinical practice guidelines define and guide management of this complex disease; these include recommendations from the United States (American Congress of Obstetricians & Gynecologists - ACOG), Canada (Society of Obstetricians and Gynaecologists of Canada - SOGC), the United Kingdom (National Institute for Health and Care Excellence - NICE), New Zealand, and the World Health Organisation (WHO). Preeclampsia is broadly defined as BP =140/90 on two separate occasions, 6 hours apart, after 20 weeks' gestation, with proteinuria (=300 mg/24h). The 2013 ACOG guidelines for hypertensive disorders of pregnancy stipulate that a pregnant or newly postpartum woman has severe preeclampsia if she meets blood pressure criteria and exhibits any signs or symptoms of organ system dysfunction (e.g., headache, visual disturbances, pulmonary oedema, or right upper quadrant pain), irrespective of whether there is documented proteinuria. Prompt diagnosis of preeclampsia is of paramount importance. Ultimately, the cure for preeclampsia is delivery of the foetus, with temporising measures targeting pharmacologic treatment of hypertension and seizure prevention with magnesium sulfate. Antenatal corticosteroid administration to promote foetal lung maturation is recommended prior to 34 weeks' gestation (or 37 weeks' gestation when delivery is probable within 7 days) [1]. The diagnosis of preeclampsia is associated with both maternal morbidity (e.g., eclampsia, HELLP syndrome) and foetal risks (e.g., placental abruption, impaired uteroplacental perfusion or intrauterine growth restriction) as well as future maternal cardiovascular and cerebrovascular disease. The risks posed to the foetus increase the chance of urgent or emergency cesarean delivery.