Recent advances in the diagnosis and management of pre-eclampsia

Abstract

Pre-eclampsia is an elusive condition to diagnose and a complex disease to manage. There have been recent developments in prediction, prevention, diagnosis, and management. Risk modelling has been used to identify women at highest risk of developing pre-eclampsia as well as predicting maternal adverse outcomes in confirmed disease. New evidence has shown that aspirin prophylaxis significantly reduces early onset pre-eclampsia as well as preterm birth. The criteria for the diagnosis of pre-eclampsia are evolving, and proteinuria is no longer a pre-requisite to make a diagnosis. Angiogenic biomarker testing accelerates diagnosis as well as minimises adverse maternal outcomes and has been incorporated into national guidelines. Emerging evidence demonstrates that expedited delivery in late preterm pre-eclampsia may be protective against maternal adverse outcomes but increase the risk of neonatal unit admission. Both women and their offspring are at increased risk of long-term health complications following pre-eclampsia, and it is important that postnatal health is optimised. This article summarises recent developments in the field of pre-eclampsia research, evaluating the impact on clinical care for women at risk of, or with suspected or confirmed, pre-eclampsia.

Keywords: angiogenic biomarkers; diagnosis; placental growth factor; pre-eclampsia.

Figure 1.. Time to delivery (median, interquartile range) stratified by PlGF concentration for all participants and for pre-eclampsia cases.

Red line indicates very low PlGF (<12 pg/ml), orange line indicates low PlGF (< fifth centile), and green line indicates normal PlGF (≥ fifth centile). PlGF, placental growth factor. This figure was reproduced from Duhig et al. under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).