Serum B-HCG, PAPPA and Uterine Artery Doppler in the Prediction of Preeclampsia and Intrauterine Growth Restriction

Abstract

SUMMARY H ypertensive disorders during pregnancy constitute a serious health problem and are associated with increased risk of maternal-perinatal adverse outcome. One main goal of prenatal care is to improve the outcome of pregnancy in terms of perinatal morbidity and mortality by identifying women at risk of complications of preeclampsia and IUGR. Preeclampsia is a multisystem disorder that complicates 3–8% of pregnancies and constitutes a major source of morbidity and mortality worldwide. Overall, 10–15% of maternal deaths are directly associated with preeclampsia and eclampsia. The criteria that define preeclampsia have not changed over the past decade. These are onset at 20 weeks’gestational age of 24-h proteinuria >30 mg/dl or, if not available, a protein concentration >30 mg (>1+ on dipstick) in a minimum of two random urine samples collected at least4–6 h but no more than 7 d apart, a systolic blood pressure >140mmHg or diastolic blood pressure >90 mmHg as measured twice, using an appropriate cuff, 4–6 h and less than 7 d apart, and disappearance of all these abnormalities before the end of the 6th week postpartum. Preeclampsia and fetal growth restriction (FGR) have also been identified as antecedent causes in 6% and 10% of perinatal deaths, respectively. Modern antenatal care provision is focused on a risk-based approach to monitoring for adverse pregnancy outcomes such as preeclampsia, fetal growth restriction, placental abruption, and stillbirth. Increasingly, research is geared toward early identification of risks, thereby allowing early commencement of management strategies to minimize the risk of adverse outcome, including facilitation of an appropriate level of pregnancy monitoring. Preeclampsia may cause many serious maternal complications like eclampsia, HELLP syndrome, liver rupture, pulmonary edema, renal failure, disseminated intravascular coagulopathy (DIC), hypertensive encephalopathy and cortical blindness. Moreover, there are many fetal complications of preeclampsia such as stillbirth, intrauterine growth restriction (IUGR), hematologic and neurological problems, bronch-opulmonary dysplasia and many other complications. Although preeclampsia has been defined by physicians for millennia, relatively little is known about its pathogenesis or prevention. Predicting its development is often extremely difficult, perhaps leading the Greeks to use the name “eklampsis “ meaning lightening. Much research has been done to identify unique screening tests that would predict the risk of developing preeclampsia before the classic symptoms appear. Doppler ultrasound has been demonstrated to be a reliable, non-invasive method of examining utero-placental perfusion. Scientific interest is now focused on early first-trimesteric examination.