Estimated reading time: 4 minutes
Preeclampsia is something every OBG resident sees almost every day. Honestly, it’s so common that we sometimes forget how serious it actually is. In India, the numbers are worrying. Roughly one in every 10 to 20 pregnant women develops preeclampsia. That means almost every clinic or ward has multiple such patients.
What’s frustrating is this — even after so many years of research, and despite India being a high-risk population, we still struggle with predicting and preventing preeclampsia effectively. This session by Dr. Aditya Nimbkar focuses exactly on that: what we can predict today, what we can actually do, and where the future might be headed.
What Exactly Is Preeclampsia?
By definition, preeclampsia means:
- Blood pressure more than 140/90 mmHg
- Recorded on two occasions, at least 4 hours apart
- After 20 weeks of pregnancy
That part is basic, and everyone knows it. But the real issue is not diagnosis.
The real issue is prediction.
Why Does Preeclampsia Happen?
The core problem starts very early in pregnancy.
Normally, trophoblasts invade the spiral arterioles. This invasion destroys the tunica layers and converts high-resistance vessels into low-resistance ones. This change is necessary because pregnancy needs more blood flow to the placenta and fetus.
When this trophoblastic invasion is faulty:
- Blood flow to the placenta reduces
- Placental hypoxia develops
- The whole disease process begins
Angiogenic vs Anti-Angiogenic Factors
Placental hypoxia leads to increased anti-angiogenic factors, mainly:
- sFlt-1
- Soluble endoglin
At the same time, pro-angiogenic factors reduce:
- Placental Growth Factor (PLGF)
- VEGF
Simply put:
- Less PLGF
- More sFlt-1
= higher risk of preeclampsia
PLGF Levels – Why They Matter
PLGF is one of the most useful markers we have today.
- PLGF > 100 → risk of preeclampsia is very low
- PLGF < 33 → very high chance of developing preeclampsia later
The lower the PLGF, the worse the placental function.
sFlt-1 / PLGF Ratio – Short-Term Prediction
This ratio helps predict what may happen in the next 1–2 weeks.
- Before 34 weeks
- Ratio > 85
- High risk of severe preeclampsia, eclampsia, or abruption
- Ratio > 85
- Between 34–37 weeks
- Ratio > 110
- Again, there is a high risk of serious events soon
- Ratio > 110
The cut-offs differ because PLGF and sFlt-1 levels behave differently as pregnancy advances.
Is This Test Really Useful?
Practically speaking, not for everyone.
The test is expensive, and even if it predicts risk, it doesn’t help us stop the disease. What it helps with is planning.
It tells us:
- Whether delivery may be needed soon
- Whether steroids should be given
- Whether magnesium sulfate is required
- Whether the patient needs admission and close monitoring
It reduces complications, but does not prevent preeclampsia.
Where Can We Actually Help the Patient?
Uterine Artery Doppler – Very Important
This is where real prevention starts.
Done along with the NT-NB scan, it tells us about placental blood flow.
- Low resistance → good trophoblastic invasion
- High resistance → higher risk
Key values:
- 11–14 weeks: Mean PI > 2.4
- 20–24 weeks: Mean PI > 1.4
Higher values mean increased risk of:
- Preeclampsia
- Fetal growth restriction
Aspirin – But Timing Is Everything
If the uterine artery PI is high:
- Start low-dose aspirin
- Ideally 150 mg
- Before 16 weeks
After 16 weeks, trophoblastic invasion is already complete, so starting late doesn’t provide much benefit.
Aspirin doesn’t completely prevent preeclampsia, but it can delay the onset and reduce the severity.
Other Early Predictors
Better prediction comes from combining:
- Uterine artery PI
- PLGF
- Mean arterial pressure (MAP)
If MAP > 90 in early pregnancy, future risk increases.
High-Risk Patients Need Extra Attention
Some women need close monitoring right from the first trimester:
- Previous preeclampsia or eclampsia
- History of abruption or unexplained stillbirth
- Chronic kidney disease
- Diabetes
- Autoimmune disorders like SLE
These patients benefit the most from early aspirin and strict surveillance.
What About the Future?
Many new markers are being studied:
- Placental protein 13
- ADAM-12
- Soluble endoglin
- Micro-RNAs
There are also drugs under research:
- Sildenafil
- Statins
- Metformin
At present, aspirin is all we have. But in the future, safer drugs may help us actually prevent, not just predict, preeclampsia.
Final Thoughts
Right now, our focus should be:
- Early screening
- Identifying high-risk women
- Starting aspirin on time
- Close maternal and fetal monitoring
Prediction helps, but prevention is the real goal. We’re not there yet — but we’re getting closer.
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