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Abstract

Early detection of preeclampsia

In the recent years, considerable research efforts led to a new perspective affecting our daily practice of screening, diagnostics and prognosis of preeclampsia. Namely, the discovery of the angiogenic and antiangiogenic factors such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) has revolutionized our understanding of the disease. These factors not only reflect the underlying pathophysiology but have also shown utility in predicting the onset of the disease. It is known that the »gold standard« of preeclampsia diagnosis, the measurement of blood pressure and determination of proteinuria has a poor predictive accuracy of preeclampsia-associated adverse outcomes. The use of the sFlt-1/PlGF-ratio can help to identify women at risk for complications. The application of algorithms known from the screening for chromosomal abnormalities has led to preeclampsia testing already in the first trimester. Here, a combination of maternal characteristics, uterine artery Doppler, blood pressure measurement and the determination of PlGF and placental protein A (PAPP-A) exhibits high detection rates for the later onset of the disease. Early detection would allow for intervention with aspirin. Also new developments in the therapy of the disease have been made. A pilot study was able to show a prolongation of pregnancy in patients with early onset preeclampsia by extracorporal removal of sFlt-1. Should prospective-randomized studies confirm the results, a semi-causative therapy for the disease would be available for the first time.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2013; 9(2): 126–141

Keywords
Preeclampsia, angiogenic and antiangiogeniuc factors, hypertension, sFlt-1, PlGF

Stefan Verlohren
Klinik für Geburtsmedizin, Charité – Universitätsmedizin Berlin, Berlin
Reviewer: Ulrike Friebe-Hoffmann, Ulm,
und Ekkehard Schleußner, Jena

Verlohren S. Früherkennung ... Gynakol Geburtsmed Gynakol Endokrinol 2013; 9(2): 126–141 publiziert 31.07.2013 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2013 ISSN 1614-8533