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Early-Onset Preeclampsia and HELLP Syndrome: An Overview

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Handbook of Growth and Growth Monitoring in Health and Disease

Abstract

Preeclampsia, one of the “great obstetrical syndromes,” affects ~3–5% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Preeclampsia is diagnosed after 20 weeks of gestation and is characterized by new-onset hypertension and proteinuria in previously normotensive women, which may deteriorate into maternal multiorgan damage affecting the kidneys, liver and central nervous system. This multisystem disorder is unique to human pregnancy and is the clinical manifestation of heterogeneous pathological processes. The placenta plays a key role in the underlying mechanisms leading to the development of preeclampsia as the only definitive treatment today remains delivery. Early-onset preeclampsia often has severe maternal and foetal consequences including intrauterine growth restriction, preterm delivery, low or very low birth weight, increased perinatal morbidity and mortality and a high incidence of the life-threatening HELLP syndrome, while the clinical presentation of late-onset preeclampsia is frequently mild, resulting mainly in maternal consequences. Of further importance, pregnant women with severe forms of preeclampsia and their growth-restricted foetuses are at an increased risk for developing cardiovascular disease later in life. Here we review the literature on the epidemiology, risk factors, pathophysiology, maternal and perinatal outcomes, diagnosis and management of early-onset preeclampsia and HELLP syndrome and summarize how these severe pregnancy complications are related to foetal growth and health.

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Abbreviations

ADAM12:

A disintegrin and metalloproteinase domain 12

AGA:

Appropriate-for-gestational age

beta-hCG:

Human chorionic gonadotropin beta subunit

BMI:

Body mass index

cffDNA:

Cell-free foetal DNA

DIC:

Disseminated intravascular coagulation

FGR:

Foetal growth restriction

HLA:

Human leukocyte antigen

HELLPsyndrome:

Haemolysis, elevated liver enzymes, low platelets syndrome

IUFD:

Intrauterine foetal death

IUGR:

Intrauterine growth restriction

IVH:

Intraventricular haemorrhage

KIR:

Killer-cell immunoglobulin-like receptors

LGA:

Large-for-gestational age

NICU:

Neonatal intensive care unit

NKcell:

Natural killer cell

NO:

Nitric oxide

PAPP-A:

Pregnancy-associated plasma protein A

PlGF:

Placenta growth factor

PP13:

Placental Protein 13

RBP-4:

Retinol-binding protein 4

RDS:

Respiratory distress syndrome

ROS:

Reactive oxygen species

sEng:

Soluble endoglin

SGA:

Small-for-gestational age

sVEGFR-1:

Soluble receptor for vascular endothelial growth factor-1

TNF-α:

Tumour necrosis factor-α

VEGF:

Vascular endothelial growth factor

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Acknowledgments

This work was supported in part by the Perinatology Research Branch, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, DHHS. Figure 113.2 was adapted from and used with permission by Romero et al. (2008).

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Authors and Affiliations

  1. Perinatology Research Branch, NICHD/NIH/DHHS, Wayne State University, Detroit, MI, 48201, USA

    Nandor Gabor Than, Edi Vaisbuch, Chong Jai Kim, Offer Erez, Lami Yeo, Pooja Mittal, Sonia S. Hassan & Roberto Romero

  2. Department of Obstetrics and Gynecology “B”, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, 84101, Israel

    Offer Erez

  3. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, H-1125, Hungary

    Petronella Hupuczi

  4. 1st Department of Obstetrics and Gynaecology, Semmelweis University, Budapest, H-1088, Hungary

    Tibor Varkonyi & Zoltan Papp

  5. Perinatology Research Branch, NICHD/NIH/DHHS, Wayne State University, Detroit, MI, 48201, USA

    Shali Mazaki-Tovi

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  1. Nandor Gabor Than
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Correspondence to Nandor Gabor Than .

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  1. Dept. Nutrition & Dietetics, King's College, Stamford St. 150, London, SE1 9NH, United Kingdom

    Victor R. Preedy

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Than, N.G. et al. (2012). Early-Onset Preeclampsia and HELLP Syndrome: An Overview. In: Preedy, V. (eds) Handbook of Growth and Growth Monitoring in Health and Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1795-9_113

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