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Early pregnancy prediction of preeclampsia

Errol R Norwitz, MD, PhD, MBA
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG


Preeclampsia refers to the onset of hypertension with proteinuria and/or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman (table 1). The clinical manifestations of preeclampsia can appear any time from the late second trimester to the first few weeks postpartum; however, the blueprint for the disease is laid down in early pregnancy and is characterized by abnormal remodeling of the maternal spiral arteries at the placental site.

Preeclampsia cannot reliably be predicted. There are currently no tests available in early pregnancy that can accurately distinguish women who will go on to develop preeclampsia from those who will not [1-3]. For this reason, obstetric care providers focus primarily on early detection of the disease. All pregnant women are monitored for evidence of preeclampsia at each of their prenatal visits.

While the ability to predict which women will develop preeclampsia before they become symptomatic is of limited benefit as neither its development nor progression from the mild to severe can be prevented in most patients, and no cure exists except for delivery, accurate identification of women at risk may improve the likelihood of timely diagnosis. Early diagnosis may improve maternal and perinatal outcome by ensuring appropriate management (eg, antenatal corticosteroids for fetal lung maturation, treatment of severe hypertension, and early delivery). Furthermore, high-risk women may benefit from the initiation of low-dose aspirin therapy starting at the end of the first trimester as this may reduce the frequency of preeclampsia and associated adverse outcomes.

Screening women in early pregnancy to identify those most likely to develop preeclampsia will be reviewed here. Additional issues related to the diagnosis and management of preeclampsia are discussed separately.

(See "Preeclampsia: Clinical features and diagnosis".)

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Literature review current through: Nov 2017. | This topic last updated: Apr 27, 2017.
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