Toward a Better Diagnosis for Preeclampsia

[摘要] In medical school, students learn that the diagnostic criteria for preeclampsia are new-onset hypertension and proteinuria after 20 weeks of gestation. An accurate diagnosis is essential, because preeclampsia is a leading cause of iatrogenic prematurity; the sole known “cure” for preeclampsia is delivery of the placenta. However, in clinical practice, the diagnosis of preeclampsia may be more nuanced than the classic textbook presentation. In a subset of patients, severe preeclampsia and even eclampsia (i.e., the presence of seizures) may present atypically in the absence of either hypertension or proteinuria. Diagnosing preeclampsia is further complicated by the fact that signs and symptoms of preeclampsia overlap with those of other medical conditions seen in pregnancy, such as liver disease, renal disease, chronic hypertension, and idiopathic thrombocytopenic purpura. Moreover, the standard clinical diagnostic criteria, such as hypertension or proteinuria, are not sufficiently accurate to predict adverse outcomes associated with the disease. The American College of Obstetricians and Gynecologists recently released new guidelines modifying the diagnostic criteria for preeclampsia that broaden the inclusion criteria to further reflect the heterogeneity of the clinical presentation (1). Current emphasis on overdiagnosis may improve maternal outcomes but may also lead to worse neonatal outcomes, because iatrogenic preterm delivery could result from significant misclassification of the disease. Preeclampsia is a leading cause of maternal mortality in developed and developing countries, making an improved diagnostic tool that is linked to the pathogenesis of the disease an important goal and a crucial step toward developing new treatments.Basic research has implicated a major pathogenic role for angiogenic imbalance in the placenta in the onset and progression of preeclampsia. High circulating concentrations of antiangiogenic factors such as soluble fms-like tyrosine kinase 1 (sFlt1)3 and low concentrations of proangiogenic factors such as placental growth factor (PlGF) released by the placenta contribute to …

[学科分类] 过敏症与临床免疫学