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Preeclampsia (PE) is a pregnancy-specific condition and is
associated with high maternal mortality and morbidity as well as risk of
perinatal death, preterm birth, and intrauterine growth restriction.

It occurs in 4 to 7 per cent of pregnant women worldwide. The
etiology of preeclampsia                   remains unclear despite
extensive research.

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The clinical pathway of severe pre-eclampsia may be correlated
with progressive deterioration in both maternal and fetal outcomes. Thus,
because delivery is the only wayof arresting the disease, there is broad
agreement on delivery in the presence of multi-organ dysfunction, fetal
distress or once a gestation of 34 weeks has been reached.

1) Ganesh KS et al in 
case-control study  conducted at
District Lady Goschen Hospital  Kannada
district, Karnataka, South India in 2016, comprised of  100 pregnant women with  pre-eclampsia as cases and 100 controls were
those pregnant women without pre-eclampsia.

 It reviews that risk
of pre-eclampsia needs to be identified early and high-quality antenatal care
should be provided for better maternal and fetal outcomes by minimizing

2) Mooij et al in a
retrospective medical record study that was performed in Ndala Hospital,
Tanzania for a period of July 2011 and December 2012 including patients
diagnosed with     severe pre-eclampsia
or eclampsia. Out of the 3398 deliveries, 26 were diagnosed with        severe pre-eclampsia and 55 with
eclampsia (0.8 and 1.6 %) along with 6 maternal deaths in patients diagnosed
with eclampsia (case fatality rate 11 %). Eclampsia convulsions were       categorised as antepartum (44 %),
intrapartum (42 %) and postpartum (15 %). 
About 100 % of eclampsia patients with convulsions were effectively
treated with Magnesium. It concludes that 2.4 % of women were diagnosed with
severe pre-eclampsia or eclampsia. Significantly better outcomes can be
achieved by effective management of hypertension and starting induction of labour
at the earliest indication.

3) Singh A et al in this retrospective, observational
study of pre-eclampsia diagnosed patients for a period of three years (2012 to
2014) at a tertiary care hospital of Delhi. It results in analysis of 224
patients of total of which 40% were booked and 76.8% cases were of age group
21-30 years, with 58.9% primigravida patients. About 82.1% with gestational age
of ?34 weeks and 5.4% were below 30 weeks. LSCS (lower segment cesarean
section) was performed in 14.2% severe pre-eclampsia patients and 7.2% mild
pre-eclampsia cases. The most common complication was prematurity in about
67.9% of cases, followed by birth asphyxia in 21.4% of patients and perinatal
mortality in 12.5% cases. Partial HELLP and HELLP were observed in 37.5% of
patients, eclampsia in 1.8% patients; other complications included DIC
(disseminated intravascular coagulation) and pulmonary edema in 3.6% of cases
each and maternal mortality rate was 1.8%. It concludes that adverse outcomes
of pre-eclampsia can be minimized by quality obstetric care only. Hence there
may be a need for research into the prevention, early diagnosis, and management
including neonatal care of pre-eclampsia.

4) Shamsi U et
al in a case-control study to assess the risk factors associated with preeclampsia
in maternity hospitals of Karachi and Rawalpindi, for  time period of  January 2006 to December 2007 involved 131
cases of PE and 262 controls without preeclampsia. It resulted in a
multivariate analysis, which classified preeclampsia risk factors as follows:
women with family history of hypertension (adjusted OR 2.06, 95% CI;
1.27-3.35), gestational diabetes (adjusted OR 6.57, 95% CI; 1.94 -22.25),
pre-gestational diabetes (adjusted OR 7.36, 95% CI; 1.37-33.66) and mental
stress during pregnancy (adjusted OR 1.32; 95% CI; 1.19-1.46 for each 5 unit
increase in Perceived stress scale score). The study reviews that these factors
can be applied as a screening tool for preeclampsia prediction. Identification
of the previously mentioned predictors would improve the ability to diagnose
and monitor women at risk for preeclampsia, in turn minimizing the adverse
maternal and fetal outcomes.

Kim YM et al in a Needs
Assessment study of emergency obstetric and newborn care (EmONC) services in Afghanistan for management of severe PreEclampsia
/Eclampsia cases over a period of one year (2009-10).  Assessment of supplies, equipments
and services issued at 78 of the 127 facilities providing EmONC services and
interview of 224 providers was done. The study reviews that majority of
facilities had the medications and supplies required for management of severe Preeclampsia / Eclampsia,
including anticonvulsant of choice MgSO4. 1/3rd of smallest
facilities and 1/2 of larger facilities reported to use diazepam a 2nd line
drug. It was summarized that 96% of doctors and 89% of midwives percieved that
MgSO4 must be utilized in severe PE/E management, but 42% of doctors and 58% of
midwives also believed that diazepam use was needed in absence of MgSO4. Study
suggests the need to elucidate service delivery guidelines, provide refresher
training, and reinforce best practices with supervision, with emphasis on the preference
of MgSO4 over diazepam and on the significance of continuing antihypertensive therapy
after delivery.

6)  Vata et al has done 4 year retrospective hospital
based study on 172 records  out
of 7702  patients The incidence rate of preeclampsia was  2.23 % in Dilla University Referral Hospital
The common  mean ages of  19.2, 22.5 and 27.8 and 31.5 were found with preeclampsia
with a pattern of  incrementing severity
with the younger  population. Study
concludes that there is a need to
establish guidelines for the management and prevention of preeclampsia for

7) Duley L performed a  Retrospective review of community and hospital-based data obtained
from the WHO data base for estimates of maternal mortality related with hypertensive disorders of
pregnancy (HDP) in Africa, Asia, Latin America and the Caribbean. Study’s  results suggest that estimates of deaths were
similar in countries under study with Africa presenting with higher total
mortality. About 10-15% of maternal deaths were found to be associated with
hypertensive disorders of pregnancy, and eclampsia was cause of 10% of maternal
mortality overall. It concludes that maternal deaths related to hypertensive
disorders of pregnancy are the most difficult to prevent. Optimized assessment
of interventions for reduction in these deaths is urgently required.

8) Lisonkova
S et al examined
population-based incidence of early-onset (<34 weeks) and late-onset preeclampsia (?34 weeks) among all singleton deliveries (n = 456,668), in Washington State for study period of 2003-2008. Cox and logistic regression models were utilized to attain adjusted hazard ratios and odds ratios (AORs) for risk factors and birth outcomes, respectively. Results show that of total 3.1% cases were of preeclampsia with its incidence rising sharply with gestation age; early- and late-onset preeclampsia had incidence rates of 0.38% and 2.72%, respectively. Study reviews that Early- and late-onset preeclampsia has some etiological features in common, differing in several risk factors, and leads to varying outcomes. Both the preeclampsia types should be treated as separate entities from an etiological and prognostic point of view. 9) Ananth CV et al  in his population based retrospective study of National hospital discharge survey datasets over 1980-2010 in United States including about 120 million women studied the rates of preeclampsia.  The age-period-cohort analysis indicates a strong age effect, i.e. higher  maternal age  was associated with  the greatest risk of pre-eclampsia, and overall  pre-eclampsia rate was found to be  3.4%. It concludes that population prevalence variations of obesity and smoking were related with period and cohort trends in pre-eclampsia but did not explain the trends. Health results of rising obesity rates in the U S underscore that efforts to reduce obesity may improve the maternal and perinatal outcomes. 10) Parra-Cordero M et al in this case-control study that involved pre-eclampsia diagnosis of total 5367 pregnant women with no specific symptoms, by routine trans-vaginal uterine artery (UtA) Doppler at 11 + 0 to 13 + 6 weeks, of these women later diagnosed with preeclampsia were 70, with 53 late-onset (delivery ? 34 weeks) pre-eclampsia and 17 had early-onset (< 34 weeks) pre-eclampsia. The study concludes that early or late pre-eclampsia was represented with an anti-angiogenic state and flawed placentation over the three months. Regression models involving maternal characteristics, UtA Doppler and Placental growth factor (PlGF) that can probably anticipate nearly half of cases that will develop early-onset pre-eclampsia. There is need for study to help design an improved and highly population-specific pre-eclampsia diagnosis testing over the first three months of pregnancy. 11) Erez O et al in his case-control longitudinal study, including 90 normal pregnant women and 76 patients with late-onset preeclampsia (diagnosed at ?34 week). In early pregnancy (8-22 weeks) elevated matrix metalloproteinase 7 (MMP-7) and later in pregnancy (after 22 weeks) low PlGF are the strongest predictors for the sequential development of late-onset preeclampsia. Thus the study suggests that the optimal prediction of patients at risk may include a two-step diagnostic process. 12) Saxena N et al in her prospective study on 150 pregnant patients diagnosed with severe pre-eclampsia and eclampsia (>20 weeks of gestation) with the aim to study the maternal
and fetal outcome for the period of one year in a tertiary center. Results
reveal that out of 150 patients 47% were Primi and 69% were 20-30 years of age.
Of 75 preeclampsia patients, 11 suffered convulsions and 75 experienced
convulsions on admission and four patients died. Most common complaint being headache.
Caesarean section was  the prevailing
mode of delivery in about 72 (48%) women, due to failed induction. From the
total, 59% complications were related to placental abruption, renal dysfunction
and failure, postpartum hemorrhage, DIC, pulmonary edema and embolism. It
concludes that eclampsia was shown to have higher complications in both mother
and child. Early diagnosis, better antenatal care, and proper management of
severe pre-eclampsia can minimize the incidence of eclampsia.

13) Torjusen H in a prospective cohort study in
Norway, for time period of years 2002–2008 including 28?192 pregnant women. The prevalence of pre-eclampsia was
5.3% (n=1491). Lower risk of pre-eclampsia was seen in women who proclaimed to
have eaten ‘mostly’ or ‘often’ organic vegetables (n=2493, 8.8%) compared to
those who ‘sometimes’ or ‘never/rarely’ had them. High intake of organic fruit,
milk, eggs, cereals or a combined index reflecting organic consumption reported
to have no relation with pre-eclampsia. Results suggest that during pregnancy opting
for organic vegetables was related with minimized risk of pre-eclampsia.
Possible reason for this association may be that organic vegetables minimize
the exposure to pesticides.

14) Kawakita
T in A retrospective cohort
study involving singleton pregnancies, patients diagnosed with preeclampsia and
without prior cesarean at ? 34 weeks’ gestation was carried out. Among 5,506 cases
of preeclampsia (? 34 weeks’ gestation) 5,104 (92.7%) women were subjected to
inductions. Outcomes were compared using adjusted odds ratios (aORs) with 95% confidence intervals (CIs). It
concludes that induction was not attributed with higher risk of the primary
outcome, but was related to a maximum risk of ICU admissions and reduced risks
of neonatal outcomes.

15) Räisänen
S et al in this population-based cross-sectional study, relates the effects on risk
of stillbirth by pregnancy history, in Finland during 2000 and 2010, including
604047 women (?20 years
of age) with singleton pregnancies. Per 1000 deliveries the prevalence of
stillbirth was found to be 3.17. For multiparous women with no prior fetal loss
in pregnancy after adjusting for major pregnancy complications related with stillbirth
such as pre-eclampsia, placental abruption, placenta previa. Comparatively in
multiparous women with prior pregnancy loss, nulliparous women with and prior
spontaneous abortion, prevalence of consecutive stillbirth was higher.
of the number of previous deliveries, prior pregnancy loss was reported to be
an independent risk factor for abortion or stillbirth.

16) Ditisheim
A et al in this prospective cohort study to describe the early postpartum blood
pressure (BP) profile following preeclampsia. In Total 115 preeclampsia patients
and 41 normal pregnant women were included. Prevalence of various hypertensive
phenotypes by applying 24-hour ambulatory BP monitoring (ABPM), 6 to 12 week following
childbirth, was assessed along with the risk of salt sensitivity and the
variability of BP derived from ABPM parameters.  Study concludes
that, ABPM 6 to 12 weeks postpartum uncovers a high rate of masked and nocturnal
hypertension, sustained ambulatory after preeclampsia. This report may assist diagnose
women who shall be involved in a management program of postpartum
cardiovascular risk.

Timofeeva AV et al in this study intended to evaluate miRNA expression
levels in the blood plasma and placenta of pregnant women with early and late
onset preeclampsia comparing it with control group to design prerequisites for
its early non-invasive diagnosis.
Methods like miRNA deep sequencing after which
real-time quantitative RT-PCR were included, logistic regression
analysis of data was done.
the patient’s blood plasma with PE, miR-423-5p, 519a-3p, and -629-5p and
let-7c-5p were higher than 2-fold increase compared to those in placenta. The
above-mentioned miRNAs are related with PE diagnosis. Conclusion implies that for the early diagnosis of PE the miRNA -miR-423-5p may be treated as a potential candidate at the time
of targeted management of pregnancies  at

18. McKinney D et al in this retrospective cohort study
including, live-born, without anomalies singleton, deliveries that took place at
the University of Cincinnati Medical Center over the duration of 2008 to 2013. Inclusion
criteria were patients with preeclampsia onset before 34 weeks are completed
and on its management. On the basis of presence /absence of fetal growth
restriction 2 study groups were defined. Its presence was reported to be related
with a reduced time interval to delivery in women subjected to expectant
management of preeclampsia (<34 weeks). These data may aid in counseling patients concerning the expected duration of pregnancy, analyze the necessity for maternal transport and guiding decision making regarding steroids therapy. 19) Rabinovich A et al in this retrospective matched case-control study that compares 81 preterm pregnant women (28 0/7 and 36 6/7 weeks) diagnosed with pre-eclampsia and oligohydramnios low amniotic fluid index (AFI) in contrast to 81 patients with preterm pre-eclampsia and without oligohydramnios( control group ). Around 4.8% of all pre-eclampsia preterm parturients resulted with oligohydramnios. study group underwent more cesarean sections. AFI <5?cm was related with a serious neonatal morbidity such as fetal distress during labor, and majority were presented with lower fetal weight and small for gestational age (SGA). Study concludes that Oligohydramnios is an independent risk factor for perinatal morbidity in preterm pre-eclamptic parturients and its presence can guide in decision making for patients delivery and also help decide for / against conservative management. 20. Elmugabil A et al in this case-control study carried out in Omdurman Maternity Hospital in Sudan, over the period of 4 months in 2014. The preeclampsia patients were cases while healthy parturients were the control group. Atomic absorption spectrophotometer was utilized to analyze serum calcium, magnesium, zinc and copper levels. In contrast with the controls, preeclampsia patients showed increased serum magnesium 1.9 (1.4?2.5) vs. 1.4 (1.0?1.9) mg/dl and decreased median (inter-quartile) calcium 7.6 (4.0?9.6) vs. 8.1 (10.6?14.2), mg/dl. In binary logistic regression, increased magnesium and decreased calcium levels were related with preeclampsia. Study concludes significant relations between serum levels of calcium and magnesium and preeclampsia exists. Reference:

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