Diagnostic criteria[ edit ] Pre-eclampsia is diagnosed when a pregnant woman develops: In a woman with essential hypertension beginning before 20 weeks gestational age, the diagnostic criteria are: Predictive tests[ edit ] There have been many assessments of tests aimed at predicting pre-eclampsia, though no single biomarker is likely to be sufficiently predictive of the disorder.
Examples of notable tests include: Doppler ultrasonography of the uterine arteries to investigate for signs of inadequate placental perfusion. This test has a high negative predictive value among those individuals with a history of prior pre-eclampsia. Angiogenic proteins such as vascular endothelial growth factor VEGF and placental growth factor PIGF and anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 sFlt-1 have shown promise for potential clinical use in diagnosing pre-eclampsia, though evidence is sufficient to recommend a clinical use for these markers.
Studies have demonstrated that finding podocytes in the urine may serve as an early marker of and diagnostic test for preeclampsia. It was shown that the histamine-degrading enzyme diamine oxidase , which is released by extravillous trophoblasts into the maternal blood circulation, is lowered in early pregnancy in women that went on to develop early-onset preelampsia later on during gestation. It must be considered a possibility in any pregnant woman beyond 20 weeks of gestation.
It is particularly difficult to diagnose when preexisting conditions such as hypertension are present. Other disorders that can cause high blood pressure include thyrotoxicosis , pheochromocytoma , and drug misuse.
Because the pathogenesis of pre-eclampsia is not completely understood, prevention remains a complex issue. Below are some of the currently accepted recommendations. Diet[ edit ] Supplementation with a balanced protein and energy diet does not appear to reduce the risk of pre-eclampsia. Smoking cessation[ edit ] In low-risk pregnancies, the association between cigarette smoking and a reduced risk of pre-eclampsia has been consistent and reproducible across epidemiologic studies.
High-risk pregnancies those with pregestational diabetes, chronic hypertension, history of pre-eclampsia in a previous pregnancy, or multifetal gestation showed no significant protective effect.
The reason for this discrepancy is not definitively known; research supports speculation that the underlying pathology increases the risk of preeclampsia to such a degree that any measurable reduction of risk due to smoking is masked. The timing of delivery should balance the desire for optimal outcomes for the baby while reducing risks for the mother. Treatment can range from expectant management to expedited delivery by induction of labor or Caesarian section , in addition to medications.
Important in management is the assessment of the mothers organ systems, management of severe hypertension, and prevention and treatment of eclamptic seizures. Bed rest has not been found to be useful and is thus not routinely recommended. Acutely, pre-eclampsia can be complicated by eclampsia , the development of HELLP syndrome , hemorrhagic or ischemic stroke , liver damage and dysfunction, acute kidney injury , and acute respiratory distress syndrome ARDS.
Furthermore, an elevation in blood pressure can occur in some individuals in the first week postpartum attributable to volume expansion and fluid mobilization. Eclampsia[ edit ] Eclampsia is the development of new convulsions in a pre-eclamptic patient that may not be attributed to other cause. It is a sign that the underlying pre-eclamptic condition is severe and is associated with high rates of perinatal and maternal morbidity and mortality.
Associated adult diseases of the fetus due to IUGR include, but are not limited to, coronary artery disease CAD , type 2 diabetes mellitus T2DM , cancer, osteoporosis, and various psychiatric illnesses.
There is tentative evidence that ongoing exposure either by vaginal or oral sex to the same semen that resulted in the pregnancy decreases the risk of pre-eclampsia.
Consistent with the fact that human immune systems tolerate things better when they enter the body via the mouth, the Dutch researchers conducted a series of studies that confirmed a surprisingly strong correlation between a diminished incidence of pre-eclampsia and a woman's practice of oral sex, and noted that the protective effects were strongest if she swallowed her partner's semen.
The team has found that certain men, dubbed "dangerous males", are several times more likely to father pregnancies that would end in either pre-eclampsia or miscarriage.