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PATHOGENESIS ANDEARLY DIAGNOSE OF

PRE-ECLAMPSIA

PRESENTED BY

RINA DWI INDRIYANI


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INTRODUCTION

Pre-eclampsia is a multisystem disease,

characterized by new-onset hypertension and

proteinuria after 20 weeks of gestation.


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INTRODUCTION

It is a leading cause of maternal and perinatal

morbidity and mortality worldwide.

The incidence of pre-eclampsia in the United

States are estimated to range between 2-6% of all

cases of pre-eclampsia, 10% for gestational age

less than 34 weeks.


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INTRODUCTION

Global incidence of pre-eclampsia has been

estimated 5-14% of all pregnancies.

In developing countries, the incidence of the

disease was reported 4-18%.


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OBJECTIVE

The purpose of writing this review of literatureis to investigate the pathogenesis and early

detection of pre-eclampsia in order to reduce

morbidity and mortality in women with pre-

eclampsia and know that prevention can be

done in pre-eclampsia.


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Department o f Obstetr ics, Campus Virchow Clin ic,

Charite University Medic ine Berl in, Germany (2012)

pathogenesis associated with angiogenic imbalance.

Circulation ofPlGF (placental growth factor) levels were reduced,

whereas [VEGF (vascular endothelial growth factor) receptor]VEGF-R, sFlt-1 [soluble Flt-1 (fms-like tyrosine kinase-1)], which

increaseD. In placental expression, mRNAand protein of sFlt-1 is

significantly increased.


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Harris Birthright Research Centre for Fetal

Medicine, Kings College Hospital, London, UK

(2010)

in pregnancy with pre-eclampsia maternal

serum concentration of PlGF and PAPP-A is

reduced.


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Department of Obstetrics and Gynaecology, Royal

Womens Hospital, Parkville, Victoria, Australia (2011)

the factors related to the placenta as a

result of oxidative stress.


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Department of Obstetrics and Gynaecology Universidad

de Los Andes, Santiago (2012)

leading to the development of pre-eclampsia can be

explained by the first phase of the invasion TO

trophoblast abnormalities that occur in early pregnancy


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Womens Hospital, Parkville, Victoria, Australia (2011)

effectiveness of most measured uterine artery Doppler in

the second trimester, it demonstrates high sensitivity for

predicting pre-eclampsia, found 29% to be detected.

there were also improvements demonstrate the

effectiveness around first trimester.


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Department of Fetal Medicine, University College

Hospital, London (2013)

several biochemical markers have been proposed for the

initial screening of pre-eclampsia, including maternal

serum or plasma endoglin levels, inhibin-A, activin-A,

Pentraxin-3 and P-selectin were increased, and PAPP-A,PlGF, and placental protein-13, which decreased.


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Department of Fetal Medicine, University College

Hospital, London (2013)

in screening for pre-eclampsia before 34 weeks, the detection rate,

the false positive rate of 10%, about 50% by maternal

characteristics, and this increased to about 90% with the additionof biophysical marker and about 75% with the addition of

biochemical markers. Detection rate increased to over 95% in

screening by an algorithm combining maternal factors, biophysical

and biochemical markers.


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discussion

Department of Obstetrics, Campus Virchow Clinic,Charite University Medicine Berlin, Germany andHarris

Birthright Research Centre for Fetal Medicine, King's

College Hospital, London, UK

Agree about pathogenesis associated with angiogenicimbalance. PlGF levels were reduced, andVEGF-R, sFlt-1

which increases.


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Harris Birthright Research Centre for Fetal Medicine,King's College Hospital, London, UK

also said the same thing that PlGF and PAPP-A is

reduced. This protein is produced by the trophoblast,and reduced concentration reflects impaired

placentation. However, PAPP-A did not remain asignificant predictor than PlGF.


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Women's Hospital, Parkville, Victoria, Australia

said there is a relationship about placenta as a result of

oxidative stress.


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Department of Obstetrics and Gynaecology, Royal Women's

Hospital, Victoria, Australia

said the most effective times for detecting pre-eclampsia by uterine

artery doppler around first trimester.

Department of Obstetrics and Gynecology, St George's University of

London, UK said anything else, early screening for pre-eclampsia

had success with Doppler optimal pregnancy if carried around 24

weeks.


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Department of Fetal Medicine, University College Hospital, London, said several

biochemical markers have been proposed for the initial screening of pre-

eclampsia, which decreased. Biomarker marker is more effective when examined

at 11 13 weeks of gestation

Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital,

University of Bologna, Italy also said the same thing about the biomarkers in

early diagnosis of pre-eclampsia are more effective and sensitive when

performed on a first trimester.


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Harris Birthright Research Centre for Fetal Medicine,King's College Hospital, London, UK and Department of

Fetal Medicine, University College Hospital, London

said that combining biophysical and biochemicalmarkers can detect about 60-90% in the pre eclampsia


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Conclusion

1. The pathogenesis of pre-eclampsia associated with angiogenicimbalance, namely reduced PlGF (placental growth factor) and

VEGF-R as well as an increase in sFlt-1,

2. Early detection of a biochemical or biomarkers can be done with

effective results at gestation weeks 11-13. And early detection

biophysics or uterine artery Doppler performed in the same

week, but it's better at the age of 24 weeks gestation.


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