Predicicón y prevención

de preeclampsia
Francesc Figueras
 10%
Aspirina (75-300 mg/d): reducción de riesgo global 47%

si inicio menos de 16s

40
60% %
47%

y si riesgo alto 60% 60%

sí Askie LM, Lancet 2007

Bujold E Obstet Gynecol. 2010
Xu TT J Clin Hypertension 2015
Roberge S Am J Perinatol 2016
Meher S Am J Obstet Gynecol 2017
Roberge S Am J Obstet Gynecol 2018
 Factores de riesgo epidemiológico

Incremento de riesgo

• PE previa , Sdr. Antifosfolipídico x8

• Obesidad, DM, HTA x4

• Enf. renal o autoinmune, E. multiple, x2-3

Nuliparidad, Historia familiar, Periodo
intergenésico, Edat

Duckitt K, Harrington D. Risk factors for preeclampsia at antenatal booking: systematic review of
controlled studies. BMJ 2005; 330:565
 Factores de riesgo epidemiológico

1+ Major criteria
Previous preeclampsia 3%
Renal disease
Autoimmune disease 7,2%
Diabetes Mellitus
Chronic hypertension
Multiple gestation
27,6%
2+ Minor criteria
Primiparity
Personal history factors
Maternal age >35 y 20,4%
African American Race
Familiar history of preeclampsia
BMI > 30 kg/m²

ACOG Committee Opinion 743 (2017)

 Factores de riesgo epidemiológico

Riesgo de recurrencia en función del debut

Barton JR, Obstet Gynecol 2008; 112 (2Pt1): 359-72

Dildy GA, Seminars Perinat 2007; 31: 135-41
Sibai B, 1992, Chames 2003
First trimester screening for preeclampsia based on maternal cgaracteristics, biophysical parameters andangiogenic factors.
Prenatal Diagnosis 2014

Epidemiologic risk factors

DR: ~50%
(FP 5-20%)
Doppler de las uterinas
 Doppler de las uterinas

19-23 s PE

Detección para 10% de FP

PE< 34s ~ 80-90%

¿Cribado poblacional? Es el mejor método por el momento...

¿Sirve para estratificar el riesgo?
 Doppler de las uterinas
Do knowledge of uterine artery resistance in the second trimester and targeted surveillance
improve maternal and perinatal outcome? García B Ultrasound Obstet Gynecol. 2016
Control habitual N~12,000 gestates
Doppler uterinas II TM
 Doppler de las uterinas

19-23 s PE/CIR

Detección para 10% de FP

PE< 34s ~ 80-90%

¿Cribado poblacional? Es el mejor método por el momento...

¿Sirve para estratificar el riesgo? NO
 Doppler de las uterinas

19-23 s PE/CIR

Detección para 10% de FP

PE< 34s ~ 80-90%

¿Cribado poblacional? Es el mejor método por el momento...

¿Sirve para iniciar profilaxis con AAS?

Doppler de las uterinas
 Doppler de las uterinas

19-23 s PE/CIR

Detección para 10% de FP

PE< 34s ~ 80-90%

Cribado poblacional? Es el mejor método por el momento...

¿Sirve para iniciar profilaxis con AAS? NO

11-13 s 19-23 s PE/CIR
 11-13 s PE

Duckitt K, BMJ 2005; 330:565

Audibert F 2010; Akolekar R 2011; Rizzo G 2008; Melchiore K 2008; Martin AM 2001; Pilalis A
2007
First trimester screening for preeclampsia based on maternal cgaracteristics, biophysical parameters andangiogenic factors.
Prenatal Diagnosis 2014

Factores epidemiológicos
Doppler arteria uterina

DR ~ 70%
(FP 5%-20%)
 Presión arterial

11-14 sg PE

• Tensión arterial
Detección para 10% de FP
PE< 34s ~ 50%

Poon LC,. Hypertensive disorders in pregnancy: screening by systolic diastolic and mean arterial pressure at 11-13
weeks. Hypertens Pregnancy. 2010;30(1):93-107
First trimester screening for preeclampsia based on maternal cgaracteristics, biophysical parameters andangiogenic factors.
Prenatal Diagnosis 2014

Factores epidemiológicos
Doppler arteria uterina
Presión arterial

DR ~ 80%
(FP 5%-20%)
 Caso clínico

11-14 w PE

sFlt

Angiogenic profile PlGF

PlGF
Anti-angiogenic profile sFlt
First trimester screening for preeclampsia based on maternal cgaracteristics, biophysical parameters andangiogenic factors.
Prenatal Diagnosis 2014

Factores epidemiológicos
Doppler arteria uterina
Presión arterial

DR ~ 80%
(FP 5%-20%)
First trimester screening for preeclampsia based on maternal cgaracteristics, biophysical parameters andangiogenic factors.
Prenatal Diagnosis 2014

Factores epidemiológicos
Doppler arteria uterina
Presión arterial
PlGF

DR ~ 90%
(FP 5%-20%)
Best practice recommendation: first‐trimester combined test is most
predictive of preterm PE … The best model is the one that combines
maternal risk factors with MAP, PLGF, and UTPI

Pragmatic practice recommendation: Where it is not possible to

measure the biochemical markers and/or UTPI, the baseline
screening test should be a combination of maternal risk factors with
MAP, and not maternal risk factors alone.
Combined screening at 1st
trimester
 Study
population=25,797

Risk <= 1/100=23,090

Risk > 1/100=2707
PE<37w 0,2%

Declined
n=1116
PE<37w 6.2%

Aspirin
Placebo
150 mg/d
n=806
n=785

Rolnik DL. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. NEJM 2017
 Preeclampsia < 37 w
5
Plac
Preeclampsia < 37 w 4 Asp

%
2

1
Preeclampsia < 34 w

0.0 0.5 1.0 1.5

Placebo Aspirin
OR (95% CI) 150 mg/d

Rolnik DL. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. NEJM 2017
 1571 neonates were liveborn

Days in neonatal intensive care

68%

Aspirin
Placebo
150 mg/d
Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit
Wright D. AJOG 2018
Best practice recommendation: women identified at high risk
should receive aspirin commencing at 11–14+6 weeks of
gestation at a dose of ~150 mg to be taken every night until
either 36 weeks of gestation, when delivery occurs, or when PE
is diagnosed

Pragmatic practice recommendation: Where it is not possible

to source the above suggested aspirin regime, the minimum
dosage of aspirin to be prescribed to high‐risk women should be
100 mg/d.