Vascular Health and Risk Management Open Access Full Text Article Dovepress open access to scientific and medical research R e V i e w Pre-eclampsia: pathophysiology, diagnosis, and management Jennifer Uzan1 Marie Carbonnel1 Olivier Piconne1,3 Roland Asmar2 Jean-Marc Ayoubi1 1Department of Gynecology and Obstetrics, Hôpital Foch, Suresnes, France; 2Foundation Medical Research institutes, Geneva, Switzerland; 3Department of Gynecology and Obstetrics, Hôpital Antoine Béclère, Clamart, France Correspondence: Jean-Marc Ayoubi Service de Gynécologie et Obstétrique, Hôpital Foch, 92151 Suresnes Cedex, France Tel +331 4625 2228 Fax +331 4625 2759 email jm.ayoubi@hopital-foch.org Abstract: The incidence of pre-eclampsia ranges from 3% to 7% for nulliparas and 1% to 3% for multiparas. Pre-eclampsia is a major cause of maternal mortality and morbidity, preterm birth, perinatal death, and intrauterine growth restriction. Unfortunately, the pathophysiology of this multisystem disorder, characterized by abnormal vascular response to placentation, is still unclear. Despite great polymorphism of the disease, the criteria for pre-eclampsia have not changed over the past decade (systolic blood pressure .140 mmHg or diastolic blood pressure $90 mmHg and 24-hour proteinuria $0.3 g). Clinical features and laboratory abnormalities define and determine the severity of pre-eclampsia. Delivery is the only curative treatment for pre-eclampsia. Multidisciplinary management, involving an obstetrician, anesthetist, and pediatrician, is carried out with consideration of the maternal risks due to continued pregnancy and the fetal risks associated with induced preterm delivery. Screening women at high risk and preventing recurrences are key issues in the management of pre-eclampsia. Keywords: pre-eclampsia, epidemiology, pathophysiology, therapeutic management Introduction The criteria that define pre-eclampsia have not changed over the past decade.1,2 These are: onset at .20 weeks’ gestational age of 24-hour proteinuria $30 mg/day or, if not available, a protein concentration $30 mg ($1+ on dipstick) in a minimum of two random urine samples collected at least 4–6 hours but no more than 7 days apart, a systolic blood pressure .140 mmHg or diastolic blood pressure $90 mmHg as measured twice, using an appropriate cuff, 4–6 hours and less than 7 days apart, and disappearance of all these abnormalities before the end of the 6th week postpartum. Nonetheless, some presentations of pregnancy-related hypertension combined with clinical or laboratory abnormalities or intrauterine growth restriction should also be considered as potential pre-eclampsia.1 Epidemiology Pre-eclampsia is a multisystem disorder that complicates 3%–8% of pregnancies in Western countries and constitutes a major source of morbidity and mortality worldwide.3,4 Overall, 10%–15% of maternal deaths are directly associated with pre- eclampsia and eclampsia.4 Some epidemiological findings support the hypothesis of a genetic and immunological etiology. The risk of pre-eclampsia is 2-fold to 5-fold higher in pregnant women with a maternal history of this disorder. Depending on ethnicity, the incidence of pre-eclampsia ranges from 3% to 7% in healthy nulliparas and 1% to 3% submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/VHRM.S20181 Vascular Health and Risk Management 2011:7 467–474 © 2011 Uzan et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 467