- By: Sanad Esmail, Rebecca Stanford, Philip Banfield
Although most cases are mild, ongoing surveillance is key
Pre-eclampsia complicates 2-8% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality worldwide. It is defined as new onset hypertension in pregnancy, at or after the 20th week, with substantial proteinuria (box 1).123
Pre-eclampsia is characterised by widespread maternal endothelial dysfunction in response to a compromised uteroplacental circulation, with the potential to cause multiple organ dysfunction. It can cause fetal compromise through placental insufficiency from a failure to establish the normal high flow, low resistance, placental circulation, leading to low birth weight, asymmetrical intrauterine growth restriction, and often iatrogenic or premature delivery. When complicated by new onset maternal grand mal seizures—eclampsia—maternal and perinatal mortality and morbidity increase markedly.
The low flow, high resistance placental circulation that is ubiquitous in pre-eclampsia results from inadequate trophoblastic invasion of maternal uterine spiral artery walls during placentation.45
The hypoxic-ischaemic placenta