DIAGNOS TICS
Predicting the risk of pre-eclampsia
Pre-eclampsia is one of the most common causes of maternal morbidity and mortality. However, the methods used to initially determine the presence of the disease have not changed in decades and rely on simple non-specific parameters. These markers are poor at predicting risk, and cases of pre-eclampsia often progress rapidly and unpredictably, warns Dawn Hannah.
A relatively new and more targeted approach to predicting the risk of pre-eclampsia is placental growth factor (PlGF), either in a laboratory or at the point of patient care, where it can provide results in as little as 15 minutes. This simple and rapid approach is helping to prevent the potentially life- threatening complications of undiagnosed pre-eclampsia, alleviating the burden of unnecessary admissions on maternity wards, reassuring expectant mothers and their families, and reducing potential litigation costs for healthcare providers.
The impact of pre-eclampsia Pre-eclampsia is defined by the International Society for the Study of Hypertension in Pregnancy as gestational hypertension accompanied by significant proteinuria, arising after the 20th week of gestation
in a previously normotensive woman.1,2 Pregnancy-related hypertensive conditions – predominantly, but not only pre-eclampsia – affect between 2% and 10% of single pregnancies worldwide,2-4
depending on the
demographics of each region, and around 6% in the UK,5 women of colour.6
with a higher incidence in
Some studies suggest that the incidence of pre-eclampsia is increasing, and this can in part be attributed to the rise of obesity in women of child-bearing age,4,7
as well as
other comorbidities such as diabetes2-8 lupus.4,7,9
and It is also well documented that
women who have already had pre-eclampsia are more likely to develop it in subsequent pregnancies,2,5,7 six in the UK.5
with an incidence of one in The consequences include
an increase in hospital and intensive care admissions, pre-term deliveries that can
have long-term effects on the baby and, thankfully rarely, maternal and infant deaths. Despite extensive research, its cause is relatively unclear, and diagnosis is still surprisingly challenging.
Challenges of the diagnostic pathway It has to be recognised that it is often the community midwives who are the first to identify women suspected of having pre-eclampsia and frequently the initial signs are high blood pressure and protein in the urine. However, it is a very difficult condition to recognise in its early stages; its presentation can be hugely variable between individuals. While some women present with severe symptoms, it can also have a very subtle presentation, even down to just feeling a little unwell. This is complicated further by the fact that the same non-specific symptoms can be attributed to causes other than pre-eclampsia, particularly in women who are nowadays able to achieve and maintain pregnancy despite multiple comorbidities.
Whatever the presentation, the unpredictable course of pre-eclampsia means that many maternity services tend to err on the side of caution when it comes to referring women to secondary care. Due its nature, there is a real sense of nervousness around the disease – for patients, midwives and clinicians alike – and consequently a very low threshold for admitting women to hospital for observation when they show early signs, causing concern for them and their families, as well as potentially unnecessary costs to the healthcare provider. However, at the other extreme, if women are left unmonitored and go on to develop more severe symptoms, then both mother and baby are placed at risk. Apart from
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WWW.CLINICALSERVICESJOURNAL.COM JANUARY 2023
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