Background
Preeclampsia
Placental pathophysiology in preeclampsia
Potential benefits of biochemical markers in preeclampsia
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Miss-diagnosis is still an issue in hospital- or community midwifery care owing to the multiple clinical symptoms associated with the syndrome [22]. The availability of one or several reliable biochemical indicators might thus help to ascertain a clinical diagnosis.
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Biochemical markers might allow the stratification of preeclamptic patients in different categories according to symptoms severity and/or pregnancy outcome and thus improve its clinical management [23].
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Very importantly, biomarkers might ensure a reliable early disease assessment in asymptomatic pregnant women, in particular among target groups at increased risk based on their clinical history (preeclampsia or hypertension in a previous pregnancy) or pre-pregnancy state (hypertension, obesity, autoimmune disease are examples of the latter).
Plasma concentrations | |||||
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Biochemical Marker | 1. trimester | 2. trimester | Manifest preeclampsia | Reported combinations for prediction | Altered levels are also correlated with |
sflt-1
| -- | ↑ | ↑ | - sEng, PlGF VEGF -Ultrasound | -- |
sEng
| -- | ↑ | ↑ | -sflt-1, PlGF -Ultrasound | -IUGR -HELLP -SGA |
PlGF
| ↓ | ↓ | ↓ | -sEng, sflt-1 | -SGA |
PP-13
| ↓ | ↑ | ↑ | -Ultrasound | -IUGR -Preterm delivery |
P-Selectin
| ↑ | ↑ | ↑ | Activin A, sflt-1 Other adhesion molecules | -- |
Cell-free fetal DNA
| ↑ | ↑ | ↑ | -Inhibin-A | -IUGR -polyhydramnios -trisomy 21 -preterm labour |
Cell free DNA
| -- | -- | ↑ | ||
ADAM12
| ↓ | -- | -- | -- | -trisomy 21 -trisomy 18 -small for gestational age |
PTX3
| ↑ | ↑ | ↑ | -- | -IUGR |
PAPP-A
| ↓ | ↓ | ↓ | -- | -birthweight |
Visfatin
| -- | ↑↓ | ↑↓ | -- | -type-2 diabetes mellitus - gestational diabetes mellitus -obesity -IUGR |
Adreno-
medullin
| ↑ | ↑ | ↑ | -- | -vascular disorders |