Introduction

• PREECLAMPSIA AND ECLAMPSIA AFFECTING 2-5%

PREGNANCY WORLDWIDE
• PREECLAMPSIA AND ECLAMPSIA IS THE THIRD CAUSE
OF MATERNAL MORTALITY IN THE WORLD, CAUSING
42% DEATH
• IN INDONEISA, THE MORTALITY DEATH IS 305 PER
100.000 DELIVERY, WITH PREECLAMPSIA AS THE
SECOND MAIN CAUSES.
 Introduction
• THE TRADITIONAL WAY TO PREDICT PRE ECLAMPSIA IS BY EXAMINING THE
MATERNAL CHARACTERISTICS, BUT THAT WAY HAVE POOR PERFORMANCE
(DR=35%)

• NEW APPROARCH TO DIAGNOSE PRE ECLAMPSIA IS THE COMBINATION OF

MATERNAL CHARACTERISTCS, BIOPHYSICAL EXAMINATION AND BIOCHEMISTRY
CHARACTERISTCS (DR =95%)
INTRODUCTION

• THE MOST COMMON WAY TO PREVENT PREECLAMPSIA AND

ECLAMPSIA IS BY ADMINISTRATING ASPIRIN BEFORE 16 WEEKS OF
GESTATION

• NEW PREVENTION OF PRE ECLAMPSIA AND ECLAMPSIA :

• L-ARGININE, DECRREASE THE INCIDENCE RATE UPTO 26%

• 5- MTHF
Introduction
• THE RIGHT SELECTION OF DIAGNOSIS AND PREVENTION METHOD CAN HELP
DECREASE THE MORTALITY AND MORBIDITY RATE ON BOTH THE MOTHER AND
THE FETUS.

• THE PURPOSE OF THIS LITERATURE REVIEW IS TO GIVE INFORMATION ABOUT

RECENT DIAGNOSIS APPROACH AND PREVENTION METHODS.
• SCREENING USING MATERNAL CHARACTERISTICS AT 11-13 WEEKS’
GESTATION
• WOMAN SHOULD BE CONSIDERED TO BE AT HIGH RISK OF THE
DEVELOPMENT OF PREECLAMPSIA IF THET HAVE ANY 1 HIGH-RISK FACTOR
OR ANY 2 MODERATE-RISK FACTOR
• DR FOR ALL PREGANANCY, <34 WEEKS, <37 WEEKS ARE 35%, 44%, 40%
• SCREENING USING COMBINATION OF MATERNAL CHARACTERISTICS,
BIOPHYSICAL MARKER, BIOCHEMISTRY MARKER
• BIOPHYSICAL MARKER ARE MAP AND UtA-PI
• BIOCHEMISTRY MARKER ARE PIGF AND sFLt-1
• DR FOR THIS COMBINATION EXAMINATION ARE 82.5% ON EARLY ONSET
PREECLAMPSIA AND 72.6% ON LATE ONSET PREECLAMPSIA
• ASPIRIN 150 mg/days ADMINISTRATION START AT 11-13 WEEKS’S
GESTATION UNTIL 36 WEEKS.
• INCIDENCE RATE IN PREECLAMPSIA IS 1,6%, COMPARING TO CONTROL IS
4,8%
• THE INCIDENCE RATE OF PREECLAMPSIA AND ECLAMPSIA IN PLACEBO
GROUP IS 10,8% , MEANWHILE THE ASPIRIN GROUP IS 8,2%

• THE PLASEBO GROUP HAVE RELATIVE RISK 1.29 TIMES HIGHER THAN
THE ASPIRIN GROUP
• AT 11-13 WEEKS’ GESTATION, BIOPHYSICS MARKER USED IS UtA-PI AND
MATERNAL CHARACTERISTICS.
• THE DETECTION RATE OF COMBINATION FROM MATERNAL HISTORY
AND BIOPHYSICS MARKER IS 80%, 70%, AND 52% FOR PREECLAMPSIA
<34 WEEKS, <37 WEEKS, AND ALL PREGNANCY
• BIOMARKER USED ARE PAPP-A AND PIGF. COMBINATION FOR ALL
EXAMINATION ARE 88%, 75%, AND 54% FOR PREECLAMPSIA <34
WEEKS, <37 WEEKS, AND ALL PREGNANCY
• IN FIRST TRIMESTER, BIOMARKER USED IS PAPP-A AND PIGF
• sFLT-1 CAN BE USED AS A MARKER AFTER 15 WEEKS’ GESTATION
• DR OF MATERNAL CHARACTERISTICS, BIOPHYSICS MARKER, AND BIOCHEMISTRY
MARKER IN 37 WEEKS’ GESTATION ARE 47%, 81%, AND 71%
• BIOMARKER USED IN 19-24 WEEKS’ GESTATION IS sFLT-1 AND PAPP-A
• COMBINATION OF ALL EXAMINATION ARE 85% AND 44% FOR PREECLAMPSIA <37
WEEKS AND >37 WEEKS
• BIOPHYSICS EXAMINATION USING UtA-PI IN 11-13 WEEKS, 19-24 WEEKS, AND 30-
34 WEEKS HAS DR 39.9%, 43.1%, AND 41,5% FOR < 37 WEEKS PREGNANCY

• DR OF MAP EXAMINATION IN 11-13 WEEKS, 19-24 WEEKS, AND 30-34 WEEKS ARE
44.6%, 42.1% , AND 51.8%

• THE SERUM PLACENTAL GROWTH FACTOR WILL GIVE SIGNIFFICANT RESULT IF

BEING PERFORMED ON >20 WEEKS’ GESTATION
• sEng, sFlt-1, AND PIGF EXAMINATION IN PREGNANCY >20 WEEKS WILL IMPROVE
THE DIAGNOSIS QUALITY WITH SPECIFITY AND SENSITIVITY 20% AND 90%, 10%
AND 90%, 90% AND 30%
• sFlt-1/PIGF VALUE TO DIAGNOSE PREECLAMPSIA IN PREGNANCY <34 WEEK IS 23
(SENSITIVITY 92%, SPECIFITY 81,1%)
• sFLT-1/PGF VALUE TO DIAGNOSE PREECLAMPSIA IN PREGNANCY >34 WEEK IS 45
(SENSITIVITY 83.7% , SPECIFITY 72.6%)
• DR OF sFlt-1/PIGF EXAMINATION IN 20 WEEK, 24 WEEK, AND 28 WEEK ARE
• 3 GRAM OF L-ARGININE IS GIVEN IN >20 WEEKS’ GESTATION REDUCES
THE EFFECT OF PRE-ECLAMPSIA UNTIL 26%
• INCIDENCE OF PREMATURE DELIVERY IS LOWER IN L-ARGININE
GROUP (2.1%) COMPARING TO CONTROL GROUP (14.3%)
• NEONATES WILL HAVE HIGHER BODY WEIGHT THAN THE CONTROL
GROUP.
• 5-MTHT GROUP HAS LOWER
INCIDENCE RATE OF
PREECLAMPSIA AND ALSO IT’S
ADVERSE EFFECT THAN THE
CONTROL GROUP
• THE USAGE OF 5-MTHT CAN
REDUCE PREECLAMPSIA RATE
UPTO 18%
 CONCLUSION

• BEST APPROACH IN EARLY DIAGNOSIS IN FIRST TRIMESTER IS THE COMBINATION

OF MATERNAL CHARACTERISTICS, UtA-PI, PIGF, AND PAPP-A EXAMINATION WITH
DR 88% AND 75% FOR <34 WEEKS AND <37 WEEKS GESTATION
• BEST APPROACH IN EARLY DIAGNOSIS IN SECOND TRIMESTER IS THE
COMBINATION OF MATERNAL CHARACTERISTICS, UtA-PI, PIGF, AND sFLT-1
EXAMINATION WITH DR 85% AND 44% FOR <37 WEEKS AND >37 WEEKS
GESTATION
• THE BEST PREVENTION METHOD OF PREECLAMPSIA AND ECLAMPSIA IS L-
ARGININE THAT REDUCES THE INCIDENCE OF PREECLAMPSIA AND ECLAMPSIA
UPTO 26%