Prediction of pre-eclampsia

Here, we review the risk factors for pre-eclampsia but focus more on the predictors of pre- eclampsia and, to a lesser extent, other placental complications of pregnancy, especially gestational hypertension and intrauterine growth restriction.

The strongest risk factors for pre-eclampsia include previous pre­eclampsia, antiphospholipid antibody syndrome, pre-existing med­ical conditions, and multiple pregnancy (Table 21.4). In the authors’ opinion, all women should be screened for clinical risk markers of pre-eclampsia from early pregnancy, recognizing that there is no single predictor of pre-eclampsia among women at either low or increased risk of pre-eclampsia that is ready for introduction into clinical practice. The most promising predictors are the angiogenic factors and uterine artery Doppler velocimetry combined with other biochemical factors using multivariate models (2, 3, 15, 63-66).

However, it should be stated that very little of the informative data have been derived from populations of women who bear the greatest of experiencing complications of pre-eclampsia, namely women in less developed countries (14).

Consultation with an obstetrician or an obstetric internist/ physician should be offered to women with a history of previous pre-eclampsia or another strong clinical marker of increased pre­eclampsia risk, particularly multiple pregnancy, antiphospholipid antibody syndrome, significant proteinuria at booking, or a pre­existing condition of hypertension, diabetes mellitus, or renal dis­ease (14, 15).