Predicting and Preventing Pre-eclampsia

THE CHALLENGE THE SOLUTION MAKING A DIFFERENCE

Definition: Pre-eclampsia
• A condition that affects 2–5% of pregnant women— Use risk factors plus biomarkers.
and as high as 8–12% in some countries in Africa—
usually from around 20 weeks
Includes high blood pressure + signs of damage to an
Four useful
•
1. Mean arterial pressure (MAP)
organ system, usually liver and kidneys Fight for • A key barrier to prevention of pre-eclampsia
biomarkers in LMICs is delayed first antenatal visit or
• High blood pressure (hypertension) and protein in 2. Serum placental growth factor comprehensive, contact with the health system
urine (proteinuria) for preterm (PLGF)
EARLY Convince women of the benefits of a first
pre-eclampsia
•

3. Uterine artery pulsatility index antenatal antenatal visit early in the first trimester
Pre-eclampsia is one of the leading causes of prediction at
maternal and perinatal morbidity and mortality.
(UTPI) visits for all • Remove barriers to antenatal care such
11–13+6 weeks’ as acceptability, affordability,
4. Serum pregnancy associated women: accessibility and quality
gestation: plasma protein-A (PAPP-A) Integrate pre-eclampsia risk assessment
Globally • Pre-eclampsia is associated with a variety of •

complications as an integral part of basic first trimester

76,000 • Most common cause of death in women with evaluation protocol
women die pre-eclampsia is intracranial haemorrhage
each year • Life expectancy of women who developed IDEAL PRE-ECLAMPSIA SOLUTION
preterm pre-eclampsia, requiring delivery at Push for • Prioritise provider education, consistent
from <37 weeks, is reduced on average by 10 years comprehensive
adherence to clinical guidelines and
Universal screening: improvement in referral pathways
pre-eclampsia • Women in low-resource countries are at a All pregnant women should be screened for universal • Workforce, availability of essential
higher risk of developing pre-eclampsia preterm pre-eclampsia at 11–13+6 weeks’
health drugs, information systems, governance
gestation using a combination of maternal risk and financing must be addressed
factors and biomarkers. The best model systems
Globally • Infants born to combines maternal risk factors + MAP, PLGF & approach:
mothers with
500,000 pre-eclampsia
UTPI. PAPP-A can be considered when PLGF &
UTPI cannot be measured.
babies die are at risk of being 1. Greater international attention is needed on
each year from born prematurely — pre-eclampsia and links between maternal health and non-
delivery is the communicable diseases (NCDs) as part of the SDGs agenda.
pre-eclampsia only cure. Where resources are limited:
Routine screening for preterm pre-eclampsia 2. All countries have an obligation to implement the best
by maternal risk factors and MAP should be pre-eclampsia testing and management practices
Maternal risk factors are associated done in all pregnancies. they can.
with the development of pre-eclampsia.
3. Skill development of primary health care providers on
risk assessment, accurate BP measurement, counselling, ensuring
Major Risk Factors: Minor Risk Factors: Treatment: aspirin availability and adherence to drug treatment and follow
Pre-existing chronic Advanced maternal age, nulliparity, Women identified at high risk should receive up makes the biggest difference to pre-eclampsia outcomes.
hypertension, renal disease, short and long inter-pregnancy intervals, aspirin prophylaxis at ~150 mg per night 4. Cost effectiveness of early pre-eclampsia prediction shows
autoimmune diseases, assisted reproductive technologies, commencing at 11–14+6 weeks’ gestation, substantial cost saving; prevention and treatment
previous history of obesity, ethnicity, family history of until 36 weeks gestation. saves lives.
pre-eclampsia pre-eclampsia

Download the FIGO pre-eclampsia guidelines at: www.figo.org/preeclampsia-guidelines