Diagnosis, pathophysiology and management of pre-eclampsia: a review

• Autor(a) principal: Machado,Susana
• Data de Publicação: 2013
• Outros Autores: Neves,Marta, Freitas,Luis, Campos,Mario
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692013000300004
• topic: Diagnosis; pre-eclampsia; pregnancy; prevention; treatment; vascular endothelial growth factor

Pre-eclampsia is a multisystem disease that occurs in 2 to 8% of pregnant women and is a leading cause of maternal and perinatal morbidity and mortality. It is classically defined by new -onset hypertension and proteinuria after 20 weeks of gestation. In recent years, we have witnessed a substantial advance in the understanding of the pathogenesis of this condition. All disease subtypes are characterized by a disruption of vascular remodelling and a systemic antiangiogenic response that leads to hypertension, proteinuria, glomerular endotheliosis, HELLP (haemolysis, elevated liver enzymes, and low platelets) syndrome, and cerebral oedema-the clinical signs of pre -eclampsia and eclampsia. In the clinical practice, there is currently no reliable screening method in the first trimester of pregnancy with sufficient accuracy to identify women at high risk of developing pre-eclampsia, and only two interventions are strongly recommended by the World Health Organization for prevention of pre-eclampsia: calcium supplementation in all women with low dietary calcium intake and low -dose aspirin. Delivery is the only known cure. The treatment of pre-eclampsia and its complications is usually carried out by obstetricians but the role of nephrologists can be crucial, particularly when the condition is complicated by acute kidney injury. Several recent studies have shown an association between early -onset or severe pre -eclampsia and an increased risk of cardiovascular and/or renal disease later in life, suggesting that these women deserve a more careful monitoring programme, including clinical evaluation by nephrologists