Pregnancy consulting

Screening for preeclampsia

Generally

Preeklampsia (PE) sa celosvetovo vyskytuje v 3 až 14‰ tehotenstiev. V Európe je incidencia preeklampsie od 4 do 8%. Perinatálna mortalita pri preeklampsii sa pohybuje medzi 4 až 28‰ a prematurita sa pri preeklampsii pohybuje medzi 15 a 40%. Pri tomto pre tehotenstvo špecifickom ochorení dochádza postupne k multiorgánovému poškodeniu matky, ktoré postihuje predovšetkým obličky, pečeň, mozog, pľúca, placentu, krtvorný systém a cievy. Klinické symptómy preeklampsie sa začínajú prejavovať takmer vždy až po 20 týždni gravidity. Ultrazvukové vyšetrenie spolu s vyšetrením placentárnych hormónov momentálne ako jediné dokáže už v prvom eventuálne druhom trimestri stanoviť mieru rizika rozvoja preeklampsie. Včasný záchyt vysokého rizika rozvoja preeklampsie u matky nám umožňuje včas účinne zasiahnuť do rozvoja tohto ochorenia.

Modern classification defines preeclampsia as two separate entities of the disease:

  • Early-onset preeklampsia occurs up to the 34th week of pregnancy, due to placental endothelial disorder
  • Late-onset preeklampsia occurs in and after the 34th week of pregnancy due to a deficiency of the mother's cardiovascular system

Old classification differentiates between mild and severe preeclampsia:

  • Definition of mild preeclampsia - hypertension at rest (systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg), protein occurrence in the urine (300 mg or more per 24 hours) and lower limb swelling.
  • Definition of severe preeclampsia - hypertension with systolic blood pressure ≥ 160 mmHg and diastolic blood pressure ≥ 1140 mmHg, high degree of occurrence of protein in the urine (2.0 g per 24 hours or protein at +++ / 3 crosses in the indicator test), swollen limbs and other body parts. Serious preeclampsia is also defined by the development of mild preeclampsia symptoms prior to the 34th week of pregnancy. Severe preeclampsia occurs in 25% of women with preeclampsia

Clinical manifestation of preeclampsia:

  • It may manifest at any time after 20 weeks of pregnancy
  • Initial pathological changes occur in the placenta already in the first trimester
  • Severe preeclampsia may also have further manifestations of the disease in the mother (pulmonary oedema, liver and kidney failure, cerebral haemorrhage, placental abruption, seizures, and rarely death of the mother) and the foetus (premature birth, growth retardation, foetal death)

When?

Preeclampsia screening is performed during the first trimester with the ultrasound examination and the combined test at 12-14 weeks of pregnancy, and then after the 20th week of pregnancy during the second and third trimester.

METHOD OF PREECLAMPSIA

SCREENING IN 11-13 WEEKS OF PREGNANCY

skrining preeklampsie metodika
Preeclampsia before the 34th week of pregnancy Preeclampsia before the 37th week of pregnancy Preeclampsia in and after the 37th week of pregnancy
- Patient factors 58% 50% 38%
- Patient factors
- Measuring of central arterial pressure
65% 60% 43%
Kombinovaný test:

- Patient factors
-Meranie stredného arteriálneho tlaku
- USG meranie maternicových tepien
- Blood examination for placental hormone PLGF
80% 70% 44%
- Patient factors
- Measuring of central arterial pressure
- USG meranie maternicových tepien
- Krvné vyšetrenie placentárneho hormónu PLGF a sFlt-1
90% 75% 47%

METHOD OF PREECLAMPSIA

SCREENING IN 20 - 24 WEEKS OF PREGNANCY

skrining preeklampsie metodika v 20-24
Preeclampsia before the 34th week of pregnancy Preeclampsia before the 37th week of pregnancy Preeclampsia in and after the 37th week of pregnancy
- Patient factors 52% 47% 36%
- Patient factors
- Measuring of central arterial pressure
72% 60% 44%

- Patient factors
- Measuring of central arterial pressure
- Krvné vyšetrenie placentárneho hormónu PLGF a sFlt-1
94% 85% 45%

- Patient factors
- Measuring of central arterial pressure
- USG meranie maternicových tepien pri morfologickom vyšetrení plodu
96% 80% 44%

- Patient factors
- Measuring of central arterial pressure
- Krvné vyšetrenie placentárneho hormónu PLGF a sFlt-1
- USG meranie maternicových tepien pri morfologickom vyšetrení plodu
100% 85% 45%

METHOD OF PREECLAMPSIA

SCREENING IN 30 - 34 WEEKS OF PREGNANCY

skrining preeklampsie metodika v 30-34
Preeclampsia before the 37th week of pregnancy Preeclampsia in and after the 37th week of pregnancy
- Patient factors 34% 30%
- Patient factors
- Measuring of central arterial pressure
79% 39%
- Patient factors
- Measuring of central arterial pressure
- USG measuring of uterine pulse during so-called “USG examination of flows”
79% 40%
- Patient factors
- Measuring of central arterial pressure
- USG measuring of uterine pulse during so-called “USG examination of flows”
- Krvné vyšetrenie placentárneho hormónu PLGF a sFlt-1
98% 55%

How?

We perform ultrasound examination in the first trimester by visualizing both uterine arteries (uterinae), in which we examine the Doppler metric blood flow. Subsequently, the combined test determines the risk of preeclampsia by using ultrasound, the medical history of the patient and placental hormone values. Patients with a high risk for the possible development of preeclampsia are advised prophylactic therapy in the form of low-dose acetylsalicylic acid. At the same time, these patients undergo a second-stage screening of preeclampsia after the 20th week of pregnancy in the form of pomer-biochemical markers sFlt1/PlGF.

What is it for?

Early screening and detection of preeclampsia allow us to successfully influence the development and heal the consequential multiple organ damage of the mother and the foetus. Each patient should know her degree of the risk for preeclampsia from the first-trimester combined test. This is of the utmost importance for the outcome of prophylactic treatment with acetylsalicylic acid, since its onset administration after 17th week of pregnancy does not have an adequate effect.