Nocturnal hypertension and risk of developing early-onset preeclampsia in high-risk pregnancies

Preeclampsia is a pregnancy-specific disorder defined by new onset of hypertension and proteinuria after 20 weeks of gestation. The early detection of patients at risk of developing preeclampsia is crucial, however, predictive models are still controversial. We aim to evaluate the diagnostic performance of a predictive algorithm in the first trimester of pregnancy, in order to identify patients that will subsequently develop preeclampsia, and to study the effect of aspirin on reducing the rate of this complication in patients classified as high risk by this algorithm. A retrospective cohort including 1132 patients attending prenatal care at Clínica Dávila in Santiago, Chile, was conceived. The risk of developing preeclampsia (early and late onset) was calculated using algorithms previously described by Plasencia et al. Patients classified as high risk, in the first trimester of pregnancy, by these algorithms, were candidates to receive 100 mg/daily aspirin as prophylaxis at the discretion of the attending physician. The overall incidence of preeclampsia in this cohort was 3.5% (40/1132), and the model for early onset preeclampsia prediction detected 33% of patients with early onset preeclampsia. Among the 105 patients considered at high risk of developing preeclampsia, 56 received aspirin and 49 patients did not. Among those who received aspirin, 12% (7/56) developed preeclampsia, which is equal to the rate of preeclampsia (12% (6/49)) of those who did not receive this medication. Therefore, the diagnostic performance of an algorithm combining uterine artery Doppler and maternal factors in the first trimester predicted only one third of patients that developed preeclampsia. Among those considered at high risk for developing the disease using this algorithm, aspirin did not change the incidence of preeclampsia, however, this could be due either to the small study sample size or the type of the study, a retrospective, non-interventional cohort study.

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A Prospective Study of Placental Growth Factor Assay as a Novel Biomarker in Predicting Early-Onset Preeclampsia in High-Risk Patients

The Journal of Obstetrics and Gynecology of India ◽

10.1007/s13224-015-0793-7 ◽

2015 ◽

Vol 66 (S1) ◽

pp. 98-103 ◽

Cited By ~ 3

Author(s):

Pooja Mathur ◽

Poonam Mathur ◽

Laxmi Maru ◽

Anupama Dave

Keyword(s):

Growth Factor ◽

High Risk ◽

Prospective Study ◽

Early Onset ◽

Placental Growth Factor ◽

High Risk Patients ◽

Risk Patients ◽

Early Onset Preeclampsia ◽

Factor Assay ◽

A Prospective Study

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Screening for Preeclampsia in the First Trimester and Aspirin Prophylaxis: Our First Year

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1712124 ◽

2020 ◽

Vol 42 (07) ◽

pp. 390-396

Author(s):

Inês Lourenço ◽

Helena Gomes ◽

Joana Ribeiro ◽

Filipa Caeiro ◽

Pedro Rocha ◽

...

Keyword(s):

High Risk ◽

Early Onset ◽

Low Dose ◽

Multiple Pregnancy ◽

First Trimester ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Prophylactic Use ◽

Early Onset Preeclampsia ◽

Aspirin Prophylaxis

Abstract Objective Preeclampsia is a major cause of perinatal and maternal morbidity and mortality. Our objective is to assess the performance of a combined screening test for preeclampsia in the first trimester and the prophylactic use of low-dose aspirin. Methods Prospective study of all women attending our hospital for the first-trimester screening of aneuploidies, between March 2017 and February 2018 (n = 1,297). The exclusion criteria were multiple pregnancy and major fetal abnormalities. Preeclampsia screening was performed with an algorithm that includes maternal characteristics, and biophysical and biochemical biomarkers. High-risk was defined as a risk ≥ 1:50 of early-onset preeclampsia (before 34 weeks), in which cases low-dose aspirin (150 mg at night) was offered to these women from screening until 36 weeks. Results From the 1,272 enrolled participants, the majority were Caucasian (1,051; 82.6%) and multiparous (658, 51.7%). Fifty patients (3.9%) screened high-risk for preeclampsia, and all started a low-dose aspirin regimen, with good compliance (96%). Early-onset preeclampsia was found in 3 pregnant women (0.24%), and total preeclampsia was diagnosed in 25 (2.02%), compared with 28 (0.75%) cases of early preeclampsia (p = 0.0099) and 98 (2.62%) of total preeclampsia (p = 0.2904) before the implementation of screening. Conclusion There was a lower incidence of both, early-onset and total preeclampsia, after the introduction of universal screening and prophylactic use of low-dose aspirin. This reduction was statistically significant in early-onset preeclampsia. The association of a first-trimester combined screening model and aspirin prophylaxis appears to be useful in predicting and reducing the incidence of early-onset preeclampsia, in a routine care setting.

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Response to Apheresis measured by Angiogenic Factors in Women with Early-Onset Preeclampsia and Antiphospholipid Syndrome

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0037-1600046 ◽

2017 ◽

Vol 77 (04) ◽

pp. 379-395

Author(s):

K Mayer-Pickel ◽

U Lang ◽

M Cervar-Zivkovic

Keyword(s):

Antiphospholipid Syndrome ◽

Early Onset ◽

Angiogenic Factors ◽

Early Onset Preeclampsia

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Early-Onset Preeclampsia with Pulmonary Edema and Massive Ascites: A Rare Presentation of Severe Preeclampsia or Concomitant Diagnoses?

Health Sciences ◽

10.15342/hs.2020.244 ◽

2020 ◽

Vol 2020 ◽

Author(s):

Elizabeth St. Laurent ◽

Rebecca Fryer-Gordon ◽

Tom McNeilis, ◽

Leonard B. Goldstein

Keyword(s):

Pulmonary Edema ◽

Early Onset ◽

Hellp Syndrome ◽

Disease Process ◽

Massive Ascites ◽

Elevated Liver Enzymes ◽

Biophysical Profile ◽

Patient Reported ◽

Early Onset Preeclampsia ◽

New Onset

Preeclampsia, eclampsia, and HELLP syndrome, are a continuum of a dangerous disease process that can occur in pregnancy. Preeclampsia is defined by new onset hypertension and proteinuria. In more severe cases, preeclampsia can be associated with pulmonary edema, oliguria, persistent headaches, and impaired liver function. These symptoms reveal maternal end organ damage which may result in danger to the fetus such as oligohydramnios, decreased fetal growth, and placental abruption. The defining difference between preeclampsia and eclampsia is the presence of new onset seizure activity. HELLP syndrome occurs when the mother experiences hemolysis, elevated liver enzymes, and low platelets. This syndrome is seen in about 0.6% of pregnancies. Each of these conditions (preeclampsia, eclampsia, and HELLP) increase both the fetal and maternal morbidity and mortality rates with the most definitive cure being delivery of child and placenta.A 28 year-old Caucasian, G1P0 female at 26w4d presented to OB triage on the recommendation of her physician due to elevated uric acid levels and a recorded blood pressure of 180/110. The patient reported rapid onset of weight gain, facial edema, diminished fetal movements, and frequent headaches. Although the patient denied labor symptoms, she complained of back pain and was admitted to the hospital at 26w4d for observation due to elevated blood pressures. The patient was diagnosed with preeclampsia with severe features. As her presentation progressed, the patient developed massive ascites and pulmonary edema along with decreasing platelet counts and increasing liver enzyme values. Due to decreasing biophysical profile (BPP) scores of the fetus and decompensating lab values of the mother, an emergency cesarean was performed for the safety of mother and baby.This case presentation demonstrates the progression of hypertensive disorders of pregnancy with a rare and severe presentation of early-onset preeclampsia with severe features, pulmonary edema, and massive ascites that ultimately led to class III HELLP syndrome and extreme prematurity of the infant.

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