Evaluation * managed expectantly : -fetal well-being - absence of IUGR
Prediction and prevention of PE and IUGR · EARLY-ONSET PE AND IUGR Relation between placental and...
31
www.medicinafetalbarcelona.org/ Prediction and prevention of PE and IUGR Eduard Gratacos www.medicinafetalbarcelona.org
Transcript of Prediction and prevention of PE and IUGR · EARLY-ONSET PE AND IUGR Relation between placental and...
www.medicinafetalbarcelona.org/
Prediction and prevention ofPE and IUGR
Eduard Gratacos
www.medicinafetalbarcelona.org
www.medicinafetalbarcelona.org/
Preeclampsia
IUGR
www.medicinafetalbarcelona.org/
Normal andabnormalplacentalimplantation
www.medicinafetalbarcelona.org/
Endothelial diseaseMOTHER
DAMAGE
DYSFUNCTION
HYPERSTIMULATION
EARLY-ONSET PE AND IUGRRelation between placental and maternal disease
Endothelial disease (poor implantation)
PLACENTA
HTAHTA proteinuriaproteinuria
plateletsplateletshemolysishemolysisliverliverHELLPHELLP
eclampsiaeclampsia
IUGRIUGR
DPPNIDPPNI
FetalFetalhypoxiahypoxia
PRED
ISPO
SITI
ON
20 30 4025 35
www.fetalmedicinebarcelona.org/
EARLY-ONSET LATE-ONSET
PREECLAMPSIA
IUGR
PREECLAMPSIA + IUGR
1 %
1 %
4-8 %
4-8 %
www.medicinafetalbarcelona.org/
MATERNALMATERNALPREDISPOSITIONPREDISPOSITIONANOMALOUSANOMALOUS
PLACENTATIONPLACENTATION
PREECLAMPSIADisease of the vascular endothelium which requires
baseline hyperstimulation state (gestation)
+ maternal predisposition +/- additional insult (anomalous placentation)
GestationalAge
www.medicinafetalbarcelona.org/
PE
20 30 4025 35
0
5
10
%
EARLY-ONSET PE (1%) LATE-ONSET PE (4-8%)
PROBLEM: MANAGEMENT PROBLEM: DIAGNOSIS
Degree plac. insufficiency: HIGH Degree plac. insufficiency: LOW
Maternal predisposition + Maternal predisposition +++
Prediction 1 trimester Prediction 2-3 T
34
www.medicinafetalbarcelona.org/
EARLY(<34w)
LATE(>34w)
Maternal severe disease 83% 30%
Association IUGR 78% 15%
Abnormal Umbilical ArteryDoppler 78% 43%
Abnormal Uterine ArteryDoppler 95% 46%
Abnormal placentalpathology +++ +
Sibai’06, Levine’06, Crispi’06, Egbor’06, Zhang’03, Sibai’03
PREECLAMPSIA: EARLY VERSUS LATE
www.medicinafetalbarcelona.org/
Prediction of PE
PEPE
Detection Rates (for FPR 10%)
11-14w
LATE PE
25-50%
EARLY PE
80-90%
INTEGRATED FIRST TRIMESTER APPROACHmaternal + UtA Doppler + biomarkers
www.medicinafetalbarcelona.org/
Prediction of PE
PEPE11-14w
INTEGRATED FIRST TRIMESTER APPROACHmaternal + UtA Doppler + biomarkers
www.medicinafetalbarcelona.org/
Previous PE / antiphospholipid syndrome x8x8
BMI ≥ 35 kg/m2 / Diabetes x4x4
Nuliparity/ Multiples /Familiar history x3x3
Age ≥ 40 y., HTA, renal/autoimmune disease x2x2
•
•
•
•
Epidemiological-risk PREECLAMPSIA
Blood Pressure 1T (10% FP) Early PE Early PE ~50%~50% Late PE Late PE ~35%~35%
www.medicinafetalbarcelona.org/
Prediction of PE
PEPE
Detection Rates (for FPR 10%)
11-14w
LATE PE
25%
EARLY PE
50%
INTEGRATED FIRST TRIMESTER APPROACHmaternal + UtA Doppler + biomarkers
www.medicinafetalbarcelona.org/
Uterine''Artery'Doppler
www.medicinafetalbarcelona.org/
6"12%w
16"24%w
Before%pregnancy
www.medicinafetalbarcelona.org/
TransvaginallyFeasible throughout pregnancy
Sagittal plane
Measurement at the internal cervical os level
•
•
•
TransabdominallyFeasible after 12 weeks
Lateral plane
Measurement at the crossover with the iliac artery
•
•
•
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
www.medicinafetalbarcelona.org/
Iliac&art.
www.medicinafetalbarcelona.org/
This presentation is only partially previewed.
