The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP)

Tranquilli, Andrea Luigi; Brown, Mark; Zeeman, Gerda G.; Dekker, Gustaaf A.; Sibai, Bahaeddine M

doi:10.1016/j.preghy.2012.11.001

Cited by 377 publications

(247 citation statements)

References 13 publications

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“…20 Without early-detection strategies, PE is clinically diagnosed as new-onset hypertension with proteinuria, 20,21 and can be further subcategorized into earlyand late-onset PE. [21][22][23][24] Based on gestational age, early-onset PE is defined by new-onset hypertension at ,33 weeks plus 6 days of gestation and late-onset PE defined by new-onset hypertension .34 weeks of gestation. [22][23][24] However, the severity of PE pregnancies can be differentiated by their clinical manifestations, as outlined by clinical practice guidelines that present the adverse conditions and severe complications of PE according to the end organs affected.…”

Section: Understanding the Spectrum Of Pregnancy-related Hypertensivementioning

confidence: 99%

Placenta-derived exosomes: potential biomarkers of preeclampsia

Pillay¹,

Moodley²,

Moodley³

et al. 2017

IJN

103

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Preeclampsia remains a leading cause of maternal and fetal mortality, due to ineffective treatment and diagnostic strategies, compounded by the lack of clarity on the etiology of the disorder. Although several clinical and biological markers of preeclampsia have been evaluated, they have proven to be ineffective in providing a definitive diagnosis during the various stages of the disorder. Exosomes have emerged as ideal biomarkers of pathological states, such as cancer, and have more recently gained interest in pregnancy-related complications, due to their role in cellular communication in normal and complicated pregnancies. This occurs as a result of the specific placenta-derived exosomal molecular cargo, which may be involved in normal pregnancy-associated immunological events, such as the maintenance of maternal–fetal tolerance. This review provides perspectives on placenta-derived exosomes as possible biomarkers for the diagnosis/prognosis of preeclampsia. Using keywords, online databases were searched to identify relevant publications to review the potential use of placenta-derived exosomes as biomarkers of preeclampsia.

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Section: Understanding the Spectrum Of Pregnancy-related Hypertensivementioning

confidence: 99%

Placenta-derived exosomes: potential biomarkers of preeclampsia

Pillay¹,

Moodley²,

Moodley³

et al. 2017

IJN

103

View full text Add to dashboard Cite

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“…The study will be divided into three distinct stages: [1] identifying potential core outcomes; [2] determining core outcomes; and [3] determining how core outcomes should be measured ( figure 1). pg. 9…”

Section: Study Overviewmentioning

confidence: 99%

“…[2] Consensus out (do not classify as a core outcome): Over 70% of participants in each stakeholder group score outcome domain 'of limited importance for decision making' (score one to three) and less than 15% of participants in each stakeholder group score outcome domain 'critical for decision making' (score seven to nine); or [3] No Consensus (do not classify as a core outcome): Anything else.…”

Section: Round Twomentioning

confidence: 99%

“…For example, severe pre-eclampsia has been defined using different blood pressure thresholds, proteinuria thresholds, clinical symptoms, placental parameters, and fetal parameters. 3 The development and use of a collection of well-defined, discriminatory, and feasible outcomes, termed a core outcome set, would help to address these issues. 4 Core outcome sets are agreed minimum sets of outcomes that can be measured in a standardised manner and reported consistently in the final publication.…”

Section: Introductionmentioning

confidence: 99%

“…The method was able to reduce 227 outcomes identified by a systematic review of the literature and 33 outcomes suggested by participants to 13 consensus 'core' outcomes. Consensus was reached on four outcomes related to pregnant women: [1] maternal mortality; [2] maternal infection or inflammation; [3] preterm rupture of membranes; and [4] harm to mother from intervention. Consensus was reached on nine outcomes related to the offspring: [1] gestational age at delivery; [2] offspring mortality; [3] birthweight; [4] early neurodevelopmental morbidity; [5] late neurodevelopmental morbidity; [6] gastrointestinal morbidity; [7] infectious morbidity; [8] respiratory morbidity; and [9] harm to offspring from intervention.…”

Section: Introductionmentioning

confidence: 99%

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A protocol for developing, disseminating, and implementing a core outcome set for pre-eclampsia

Duffy

Hooft

Gale

et al. 2016

Pregnancy Hypertension: An International Journal of Women's Car

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Background Pre-eclampsia is a serious complication of pregnancy and contributes to maternal and offspring mortality and morbidity. Randomised controlled trials evaluating therapeutic interventions for pre-eclampsia have reported many different outcomes and outcome measures. Such variation contributes to an inability to compare, contrast, and combine individual studies, limiting the usefulness of research to inform clinical practice. The development and use of a core outcome set would help to address these issues ensuring outcomes important to all stakeholders, including patients, will be collected and reported in a standardised fashion. Methods An international steering group including healthcare professionals, researchers, and patients, has been formed to guide the development of this core outcome set. Potential outcomes will be identified through a comprehensive literature review and semi-structured interviews with patients. Potential core outcomes will be entered into an international, multi-perspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and patients will be invited to participate. The modified Delphi method encourages whole and stakeholder group convergence towards consensus ‘core’ outcomes. Once core outcomes have been agreed upon it is important to determine how they should be measured. The truth, discrimination, and feasibility assessment framework will assess the quality of potential outcome measures. High quality outcome measures will be associated with core outcomes. Mechanisms exist to disseminate and implement the resulting core outcome set within an international context. Discussion Embedding the core outcome set within future clinical trials, systematic reviews, and clinical practice guidelines could make a profound contribution to advancing the usefulness of research to inform clinical practice, enhance patient care, and improve maternal and offspring outcomes. The infrastructure created by developing a core outcome set for pre-eclampsia could be leveraged in other settings, for example selecting research priorities and clinical practice guideline development

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Aspirin Discontinuation at 24 to 28 Weeks’ Gestation in Pregnancies at High Risk of Preterm Preeclampsia

Mendoza

Bonacina

Garcia‐Manau

et al. 2023

JAMA

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ImportanceAspirin reduces the incidence of preterm preeclampsia by 62% in pregnant individuals at high risk of preeclampsia. However, aspirin might be associated with an increased risk of peripartum bleeding, which could be mitigated by discontinuing aspirin before term (37 weeks of gestation) and by an accurate selection of individuals at higher risk of preeclampsia in the first trimester of pregnancy.ObjectiveTo determine whether aspirin discontinuation in pregnant individuals with normal soluble fms-like tyrosine kinase–1 to placental growth factor (sFlt-1:PlGF) ratio between 24 and 28 weeks of gestation was noninferior to aspirin continuation to prevent preterm preeclampsia.Design, Setting, and ParticipantsMulticenter, open-label, randomized, phase 3, noninferiority trial conducted in 9 maternity hospitals across Spain. Pregnant individuals (n = 968) at high risk of preeclampsia during the first-trimester screening and an sFlt-1:PlGF ratio of 38 or less at 24 to 28 weeks of gestation were recruited between August 20, 2019, and September 15, 2021; of those, 936 were analyzed (intervention: n = 473; control: n = 463). Follow-up was until delivery for all participants.InterventionsEnrolled patients were randomly assigned in a 1:1 ratio to aspirin discontinuation (intervention group) or aspirin continuation until 36 weeks of gestation (control group).Main Outcomes and MeasuresNoninferiority was met if the higher 95% CI for the difference in preterm preeclampsia incidences between groups was less than 1.9%.ResultsAmong the 936 participants, the mean (SD) age was 32.4 (5.8) years; 3.4% were Black and 93% were White. The incidence of preterm preeclampsia was 1.48% (7/473) in the intervention group and 1.73% (8/463) in the control group (absolute difference, −0.25% [95% CI, −1.86% to 1.36%]), indicating noninferiority.Conclusions and RelevanceAspirin discontinuation at 24 to 28 weeks of gestation was noninferior to aspirin continuation for preventing preterm preeclampsia in pregnant individuals at high risk of preeclampsia and a normal sFlt-1:PlGF ratio.Trial RegistrationClinicalTrials.gov Identifier: NCT03741179 and ClinicalTrialsRegister.eu Identifier: 2018-000811-26

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The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP)

Cited by 377 publications

References 13 publications

Placenta-derived exosomes: potential biomarkers of preeclampsia

Placenta-derived exosomes: potential biomarkers of preeclampsia

A protocol for developing, disseminating, and implementing a core outcome set for pre-eclampsia

Aspirin Discontinuation at 24 to 28 Weeks’ Gestation in Pregnancies at High Risk of Preterm Preeclampsia

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