Preeclampsia

Contemporary prediction of preeclampsia
Elena Scazzocchioa,b and Francesc Figuerasa
a

Department of Maternal-Fetal Medicine, Institute
Clınic of Gynecology, Obstetrics and Neonatology
´
(ICGON), Hospital Clinic-IDIBAPS, University of
Barcelona and Centre for Biomedical Research on
Rare Diseases (CIBER-ER) and bObstetrics,
Gynecology and Reproductive Medicine Department,
InstitutUniversitari Dexeus, Barcelona, Spain
Correspondence to Francesc Figueras, MD, PhD,
Maternal-Fetal Medicine Department, Hospital Clinic,
University of Barcelona, Sabino de Arana 1, 08028
Barcelona, Spain
Tel: +34 93 227 5600; fax: +34 93 227 5605;
e-mail: ffiguera@clinic.ub.es
Current Opinion in Obstetrics and Gynecology
2011, 23:65–71

Purpose of review
To provide a concise review ofadvances in prediction of preeclampsia, highlighting the
most important and interesting articles among the many published within the past
months, making a clear distinction between early and late clinical forms of the condition.
Recent findings
The performance of maternal levels of angiogenic factors to predict preeclampsia,
especially early-onset preeclampsia, could be further improved by combiningseveral
markers and by evaluating the longitudinal changes between the first and second
trimester. Combining first trimester angiogenic factors with maternal history, mean
blood pressure and uterine artery Doppler achieves a detection rate of approximately
90% for an approximately 10% of false positives for early preeclampsia. The
incorporation of parameters reflecting maternal vascularstiffness into multiparametric
models in contingent strategies might result in fewer tests than concurrent screening,
with similar prediction performance.
Summary
Combining several tests into multiparametric models results in the early identification of
the vast majority of cases bound to develop early preeclampsia, which is the clinical form
that most contributes to adverse maternal and perinataloutcome. This may allow more
efficient allocation of resources according to the individual risk and the evaluation of
prophylactic strategies in a selected subgroup of women.
Keywords
biological markers, prediction, preeclampsia, pregnancy complications, screening
Curr Opin Obstet Gynecol 23:65–71
ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
1040-872X

IntroductionPreeclampsia affects about 2–3% of pregnancies and is a
major contributor to maternal mortality with an estimate
of 100 000 deaths a year worldwide [1]. It is also the first
cause of maternal admission to intensive care units [2]
and is associated with an increased risk of perinatal
mortality, being responsible for 10% of stillbirths [3]
and 15% of preterm births [4]. Altogether, the additional
costof an average case of preeclampsia in developed
countries has been estimated at £9000 [5]. Thus, predicting preeclampsia is a major challenge in contemporary obstetrics. The importance of this condition is
stressed when confidential enquiries are analysed, showing that in a substantial proportion of cases of fetal death
due to preeclampsia a different management might have
altered the outcome[6]. An accurate prediction of preeclampsia may, therefore, allow more efficient allocation
of resources for monitoring and improving maternal and
perinatal outcomes.
In the past, the evaluation of the prediction of preeclampsia has been blurred by lumping together different
1040-872X ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

clinical forms of this condition. In recentyears it has
become accepted that early-onset and late-onset preeclampsias are associated with different biochemical,
histological and clinical features [7–9]; whereas the
early-onset form is almost invariably associated with
placental insufficiency and growth restriction, the lateonset form is more prevalent and, in general, placental
involvement is minimally present. A recent finding supporting...