Detecting PreeclampsiaKatlyn Joy |18, December 2013
Preeclampsia is a serious condition that can occur during pregnancy. According to the Preeclampsia Foundation, it affects 5 to 8 percent of all pregnancies and is the leading cause of maternal and fetal death and illness. Preeclampsia is responsible for 500,000 infant deaths and 76,000 maternal deaths worldwide each year.
The need for better detection of the condition is critical but so far there is no home run in terms of a test that is accurate in both determining those at highest risk and eliminating those with no risk of the illness.
The latest test to make a splash in the news is the PGIF test. This test looks at maternal blood samples for a protein that is released by the placenta. Women with preeclampsia have abnormally low levels of this protein.
The strength of this new test is in its accuracy in diagnosing women who are earlier than 35 weeks along in pregnancy with the condition. In the study of the test, done in the United Kingdom lead by researchers at Kings College, women with the condition were identified 96 percent of the time.
Another positive of the test is the rapidity of the test, with results available in as little as 15 minutes.
The Downside of PGIF Testing
The downside of the test at this point is that in women under 35 weeks gestation, 45 percent of women with healthy pregnancies were incorrectly identified by the test.
Also, for women over 35 weeks, the test is not as reliable in picking up the condition. Apparently the protein level specifically tested, PGIF, declines in the latter part of the third trimester. However, the flipside is that after 35 weeks the test is better at excluding women who don't have the condition.
Implications of PGIF
Experts believe more research needs to be done in order to best use the testing, such as PGIF, that are available. The possibility for positives from this test are earlier diagnosis in women before 35 weeks gestation, but the risk is that there will be false positives as well. Therefore, education will be necessary to make certain pregnant women don't become stressed over false test results. Doctors also must perform proper follow up on the test results to ensure that a woman definitely does or does not have preeclampsia in order to give appropriate medical care.
Preeclampsia has only one treatment — delivering the baby. The question is always not if, but when. When to deliver the baby will depend on the severity of the condition, the overall health at the time of the mother and the well-being of the fetus. Sometimes, dire circumstances do require inducing labor to deliver a baby preterm because the situation could result in the demise of the mother and therefore the child, otherwise.
New Guidelines for Diagnosing Preeclampsia
While it is an established fact that the condition of preeclampsia is a serious one, diagnosing the condition remains an evolving science. In fact, in just November 2013, the American Congress of Obstetricians and Gynecologists revised their guidelines for diagnosing preeclampsia.
No longer is evidence of elevated protein levels in the urine part of the criteria for diagnosing the condition. Researchers have learned that severe preeclampsia can occur without elevated levels, even to the extent of organ damage.
The new criteria for diagnosing preeclampsia by ACOG include the following:
- Persistent high blood pressure readings during pregnancy or during postpartum
- A development of decreased blood platelets during pregnancy or postpartum
- Protein in the urine
- Issues with kidney or liver
- Presence of fluid in the lungs
- Brain problems such as seizures or visual difficulties or symptoms
ACOG has also revised their guidelines on how to manage the condition, such as giving magnesium sulfate to women with blood pressure readings of 160/110 or higher. If a woman has lower blood pressure readings but other severe symptoms that precede stroke, she should also receive magnesium sulfate.
Delivery should be timed to correspond with the research results indicating the best results occur when delivery occurs by the 37th week of pregnancy.
Women will also be educated about the signs of preeclampsia and observed postpartum for signs of the condition. Another point of education will be to let women know once they've had the condition of preeclampsia, they are at increased risk for cardiovascular disease later in life.
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