Description
"Preeclampsia: Situation Analysis" offers a critical overview of the current status, challenges, and advancements related to preeclampsia—a leading cause of maternal and perinatal morbidity and mortality worldwide. This session will explore the prevalence, risk factors, and diagnostic gaps, particularly in low-resource settings. It will also highlight recent developments in prediction, prevention, and management strategies. By analyzing both clinical and public health perspectives, the talk aims to identify actionable insights for improving outcomes in mothers and newborns.
Summary Listen
- The speaker begins by expressing gratitude and emphasizing the value of challenging cases for learning. They introduce a real-life case of a 29-year-old woman, gravida 5 para 3, with a history of adverse pregnancy outcomes including fetal demise, stillbirth, and severe pre-eclampsia with IUGR.
- The patient's history suggests obstetric vasculopathy, which leads to early-onset pre-eclampsia, often before 34 weeks, and a stormy course. The speaker stresses the importance of distinguishing this from late-onset pre-eclampsia. The speaker highlights the shift in understanding pre-eclampsia, now focusing on the maternal cardiovascular system's role, where the placenta may be a victim.
- The initial investigations should include testing for antiphospholipid antibody syndrome (APS), as autoimmune factors may be involved. If clinical criteria for APS, such as recurrent miscarriages or pre-eclampsia, are present along with positive lab results for antiphospholipid antibodies, then APS is considered. Differentiating obstetric APS (OAPS) from thrombotic APS (TAPS) is crucial.
- Pregnancy outcomes are more favorable when APS is treated with aspirin and heparin, despite the persistent risk of complications, as the underlying cause is not fully addressed. In the non-pregnant state, low-dose aspirin should be initiated, considering a dosage of 75-150mg.
- Upon confirmed pregnancy, low-dose aspirin is continued, and heparin is considered if indicated. Heparin plus aspirin provides the best results. A history of failed aspirin treatment, positive tests for lupus anticoagulant or anticardiolipin antibodies, or severe obstetric complications are indications for starting heparin immediately.
- Unfractionated heparin at 5000 international units per day or low molecular weight heparin at 40mg daily are possible regimens. Heparin is started upon detection of fetal heart rate and discontinued around 36 weeks gestation. If uterine artery PI is elevated (above 1.7 or 2MOM) at 11-13 weeks, it signifies continued high risk and reinforces aspirin use.
- Chemical markers like PlGF, sFlt-1, and PAPPA can aid in pre-eclampsia detection. Lower levels of PlGF and PAPPA, and elevated levels of sFlt-1 or inflammatory markers are associated with increased risk.
- At mid-trimester, Doppler ultrasound, particularly umbilical artery Doppler, is critical for monitoring. Disappearance of diastolic notch in the uterine artery is a good sign. A rising blood pressure or persistent diastolic notch in the second trimester indicates caution. While drugs like Arginine, DHA, and Vitamin D3 are sometimes used, their efficacy is not well-established.
- At 26 weeks, albuminuria, reduced creatinine clearance, and altered cerebroplacental ratio (CPR) on Doppler indicate worsening condition. Anti-hypertensives, preferably labetalol, should be started, even at 130/90, especially in high-risk patients. Other options include nifedipine or hydralazine for hypertensive crisis. Antenatal steroids should be administered.
- The presented case concludes with a successful outcome, delivering a 1900g baby after careful monitoring using serial ultrasounds, even with IUGR and elevated blood pressure. The cerebroplacental ratio was used to guide decisions to delay delivery until maternal or fetal indications warranted intervention. Technology and improved drugs aid pre-eclampsia management.
Sample Certificate
About the Speakers
Dr. Pankaj Desai
Consultant Gynecologist, Janani Maternity Hospital, Vadodara, Gujarat
Comments
Comments
You must be logged in to leave a comment.