Präeklampsie-Screening im 1. und 2. Trimenon

Abstract

Pre-eclampsia is a pregnancy-associated disease of the second part of the pregnancy, occurring mainly after 20th weeks gestation. The prevalence of hypertension in pregnancy is between 5 to 11% and affects mainly women under 20 years of age. An inadequate invasion of trophoblasts with consequential placental ischemia as a result of insufficiently dilated uterine spiral arteries is thought to be an initial cause in the pathogenesis of pre-eclampsia. The clinical symptoms of pre-eclampsia, such as loss of intravascular volume and edema, are caused by generalized endothelial dysfunction. These symptoms are potentiated by hypertension and reduced colloid osmotic pressure in the plama. The organs being affected by pre-eclampsia are those of the vascular-, hepatic-, renal-, cerebral- and coagulatory systems. The prognosis is much more severe when pre-eclampsia develops very early in the pregnancy. The symptoms include elevated blood pressure (over 140 mmHg systolic, 90 mmHg diastolic) combined with proteinuria. Frequent symptoms are hyperreflexia and edema. The etiology of pre-eclampsia has not been clearly defined. Risk factors/triggers for the development of pre-eclampsia can include chronic hypertension, advanced maternal age at first pregnancy (over 35 y), nephropathy, thrombophilia (heterozygous factor V Leiden mutation, antiphospholipid syndrome, heterozygous prothrombin mutation and homozygous MTHFR), multiple gestation and prior pregnancy with preeclampsia. The incidence of preeclampsia is higher in nulliparous than multiparous women. In many countries pre-eclampsia is still most frequent cause of maternal perinatal mortality. HELLP-Syndrome (haemolysis-elevated liver enzyme- low platelets) is a severe progressive course of this disease. Eclampsia, characterized by generalized tonic-clonic convulsion, is the most dangerous complication of pre-eclampsia, and may develop before or after delivery. This form of pre-eclampsia is associated with higher maternal and fetal mortality. Constant maternal hypertension potentially alter vascular integrity of the placenta with further consequences in fetal blood supply leading to growth restriction or zero growth and subsequently resulting in low birth weight or fetal death. The sooner the disease is detected and confirmed, the better the maternal and fetal prognoses are. This is the reason why it is major importance, together with the employment of preventive measures, to identify patients with risk factors with pre-eclampsia though an adequate screening method, thereby detecting the disease earlier and ensuring better pregnancy outcomes for both mother and child.

Ocular Changes During Pregnancy

“…Pregnancy-related hypertension arises in 5% to 11% of pregnant women (9). 40% to 100% of these patients show signs of hypertensive retinopathy (10, e1), ranging from mild focal retinal vascular spasm to cotton-wool spots and hemorrhages to papilledema.…”

Hypertensive syndrome in pregnacy: How to predict

“…Sensitivity, specificity, positive and negative predictive value of micro-albuminuria was recorded as 66.67%, 93.24%, 44.44% and 97.18% respectively. The conclusion was that uterine artery Doppler study is a better screening test amongst the two 6,7 .…”

Doppler measurements in fetal descending aorta and umbilical artery can predict borderline oxygenation in pre-eclampsia and HELLP syndrome

“…Pre-eclampsia is associated with inadequate invasion of trophoblast leading to placental ischemia due to insufficiently dilated uterine spiral arteries [1]. This leads to hypertension, involving multiple organs.…”

“…Consequential there is redistribution of organ blood flow and an increase of resistance in fetal vessels leading to intrauterine growth retardation (IUGR) or fetal death [1]. Clinical diagnosis is difficult but usually associated with abdominal pain or vomiting during third trimester of pregnancy, hemolysis, increased serum bilirubin (>1.2 mg/dL), hepatic dysfunction demonstrated by increased transaminase activities (LDH > 600 IU/L), and thrombocytopenia (<100.000/µl) [2].…”

“…Clinical diagnosis is difficult but usually associated with abdominal pain or vomiting during third trimester of pregnancy, hemolysis, increased serum bilirubin (>1.2 mg/dL), hepatic dysfunction demonstrated by increased transaminase activities (LDH > 600 IU/L), and thrombocytopenia (<100.000/µl) [2]. Prognosis is poorer when pre-eclampsia develops earlier in pregnancy [1]. Although the descending aortic blood flow represents approximately 60% of fetal cardiac output, cardiotocography, serial ultrasound measurements, and Doppler flow velocimetry of umbilical artery and fetal middle cerebral arteries have commonly been used to assess fetal well-being and to guide management of pregnancies complicated with pre-eclampsia with or without HELLP syndrome [3][4][5][6][7][8].…”