Prediction and prevention of preeclampsia and IUGR.

Early Human Development (Impact Factor: 1.93). 12/2005; 81(11):865-76. DOI: 10.1016/j.earlhumdev.2005.09.005
Source: PubMed

ABSTRACT Preeclampsia, being one of the leading causes of maternal and perinatal morbidity and mortality, has been the subject of extensive research since its description. Preeclampsia has been called the disease of theories due to the enigma surrounding its exact pathophysiology. Despite the absence of treatment that reverses the disease process once started, screening for preeclampsia and intrauterine growth restriction (IUGR) has been a major clinical and research issue since the disease was first reported. This review evaluates the current evidence for prediction and prevention of preeclampsia and IUGR using clinical tests, maternal serum markers, and uterine artery Doppler screening. In addition, we critically evaluate the evidence regarding the different therapeutic strategies for the prevention of preeclampsia and IUGR and the latest clinical recommendations for their use.

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    ABSTRACT: Biomarkers associated with spontaneous preterm birth and preeclampsia have been discovered in patients who experience these adverse obstetrical outcomes. The identification of such biomarkers holds promise in both facilitating the early identification of those patients at greatest risk and enhancing our understanding of these disease processes to determine therapeutic interventions. To that end, our objective was to review the existing literature to determine the utility of biomarkers in the risk stratification of spontaneous preterm birth and preeclampsia. We found that despite the promise of some biomarkers in identifying patients at increased risk for spontaneous preterm birth and/or preeclampsia, the use of biomarkers in clinical practice to predict adverse obstetrical outcome remains challenging. Although data from small discovery studies may be encouraging, progress with biomarker research remains limited by the lack of validation of these discovered biomarkers. Furthermore, owing to the heterogeneity of existing studies, generalizable conclusions are difficult to understand, meta-analyses are challenging to perform, and agreement on cut-point standardization is difficult. The identification of an abnormal biomarker level does not guarantee whether or when an adverse clinical event might occur. Our lack of understanding of the true etiologies of these disease processes leaves us without definitive interventions to prevent spontaneous preterm birth and preeclampsia from occurring.
    Fertility and sterility 02/2013; · 4.30 Impact Factor
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    ABSTRACT: A previous study demonstrated that the increase in diastolic blood pressure during pregnancy was reduced by supplementation with magnesium. The present study was undertaken to explore if increases in diastolic blood pressure could be useful for early identification of pre-eclampsia.
    Archives of Gynecology and Obstetrics 09/2014; · 1.28 Impact Factor
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    ABSTRACT: Introducción La hipertensión del embarazo, el retraso del crecimiento intrauterino (RCIU) y el parto prematuro son enfermedades asociadas a morbimortalidad maternofetal significativa. Este estudio evalúa la utilidad de los falsos positivos y de los cambios aislados en los marcadores bioquímicos del cribado prenatal de la trisomía 21 para la identificación de un mayor riesgo para estas enfermedades. Método Se hicieron 2 estudios caso-control: uno de la asociación entre los falsos positivos por el cribado (integrado y del segundo trimestre) y aquellas enfermedades y otro de la distribución de los marcadores bioquímicos, PAPP-A, fracción libre de la beta-hCG y alfa-fetoproteína (AFP), en mujeres embarazadas afectadas y no afectadas. La población de estudio incluyó todos los 4.224 cribados realizados en el Hospital S. Francisco Xavier (Lisboa), entre marzo de 2003 y agosto de 2007. Resultados La asociación fue significativa (p < 0,05) entre el RCIU y los falsos positivos del cribado integrado y del segundo trimestre y entre el RCIU y los cambios aislados de los 3 marcadores bioquímicos. Los cambios aislados de PAPP-A y AFP se asociaron significativamente con el parto prematuro y la hipertensión del embarazo, respectivamente. Conclusión Los falsos positivos en el cribado o cambios aislados en los marcadores bioquímicos son marcadores indirectos de un mayor riesgo de efermedad placentaria. Esta información está disponible antes de las 20 semanas de gestación y puede ser utilizada en el seguimiento del embarazo.
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