A literature review and best practice advice for second and third trimester risk stratification, monitoring, and management of pre-eclampsia

Abstract

Abstract: Pre-eclampsia is a multisystem disorder that typically affects 2%–5% of pregnant women and is one of the leading causes of maternal and perinatal morbidity and mortality, especially when the condition is of early onset. Globally, 76 000 women and 500 000 babies die each year from this disorder. Furthermore, women in low-resource countries are at a higher risk of developing hypertensive disorders of pregnancy and pre-eclampsia compared with those in high-resource countries. This is because socioeconomic, educational, and environmental disadvantages have historically beset vulnerable communities, leading to nutritional disparities, poor-quality diet, obesity, and diabetes (before and during pregnancy), thus increasing the rates of pregnancy complications, in particular pre-eclampsia. Pre-eclampsia has been traditionally defined as the onset ofhypertension accompanied by significant proteinuria after 20 weeks of gestation. Recently, the definition of pre-eclampsia has been broadened. Now the internationally agreed definition of pre-eclampsia is that proposed by the International Society for the Study of Hypertension in Pregnancy (ISSHP). According to ISSHP, pre-eclampsia is defined as systolic blood pressure at ≥140 mmHg and/or diastolic blood pressure at ≥90 mmHg on at least two occasions measured 4 hours apart in previously normotensive women and is accompanied by ≥1 of the following new-onset conditions at or after 20 weeks of gestation:..(Continued)