Screening and prevention of pre-eclampsia: a review Abstract

Piya CHAEMSAITHONG, Kubi APPIAH, Daljit SAHOTA, Tak Yeung LEUNG, Liona Chiu Yee POON
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong

Pre-eclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality. Early-onset PE requiring preterm delivery is associated with a higher risk of complications in both mothers and babies. It is important to identify pregnant women who are at high risk of developing PE in the first trimester, so that preventive measures can be initiated early to improve placentation and reduce the prevalence and severity of the disorder. This review illustrates that effective screening for early-onset PE can be performed in the first trimester of pregnancy by a combination of maternal risk factors, mean arterial pressure, uterine artery Doppler ultrasonography, and placental growth factor. This prediction algorithm has detection rates of 90%, 75%, and 41% for very-early (delivery <32 weeks), preterm (delivery <37 weeks), and term (delivery ≥37 weeks) PE at 10% false positive rate, respectively. This model has been validated in several populations. Recent evidence has demonstrated that administration of low-dose aspirin (150 mg/nightly) starting at 11-14 weeks of gestation to high-risk women is effective in reducing the risk of preterm PE and the length of stay in neonatal intensive care unit.