Preeclampsia – Aetiology, Current Diagnostics and Clinical Management, New Therapy Options and Future Perspectives

Abstract

Preeclampsia is a multisystem disease for which the exact causes have not yet been sufficiently clarified. However, in the past few years it has become clear that a placental imbalance between angiogenic and anti-angiogenic proteins is the decisive pathogenetic factor for the occurrence of preeclampsia. With the possibility to measure these angiogenic factors (sFlt-1/PlGF ratio) in maternal blood full new diagnostic possibilities have been opened that enable the certain diagnosis or exclusion of the diseases as well as a short-term prognosis to be made. In secondary prevention the current data situation for ASA confirms a moderate but measurable utility. The management concept depends on gestational age. In the case of early clinical manifestations (< 34th week of pregnancy) the clinical management in a perinatal centre remains unchanged with foeto-maternal monitoring and induction of pulmonary maturation, symptomatic therapy under careful blood pressure lowering and determination of the optimal delivery time. A balance must be made here between foetal immaturity and maternal risks upon prolongations. The pathomechanism of anti-angiogenic overload with sFlt-1 provides a starting point for first therapeutic interventions. The present article gives an overview of current diagnostic options and presents possible future therapeutic perspectives for discussion.

Zusammenfassung

Die Präeklampsie ist eine Multisystemerkrankung, deren genaue Ursache noch nicht hinreichend geklärt ist. Allerdings ist in den letzten Jahren klar geworden, dass ein plazentares Ungleichgewicht zwischen angiogenen und antiangiogenen Proteinen der entscheidende pathogenetische Faktor für die Entstehung der Präeklampsie ist. Mit der Möglichkeit der Messung dieser angiogenen Faktoren (sFlt-1/PlGF-Quotient) im maternalen Blut ergeben sich völlig neue diagnostische Möglichkeiten, die die sichere Diagnose bzw. den Ausschluss der Erkrankung und darüber hinaus eine Kurzzeitprognose ermöglichen. In der Sekundärprävention belegt die Datenlage für ASS einen moderaten, aber doch messbaren Nutzen. Das Betreuungskonzept ist abhängig vom Gestationsalter. Bei früher klinischer Manifestation (< 34. SSW) ist das klinische Management im Perinatalzentrum unverändert die fetomaternale Überwachung mit Induktion der Lungenreife, symptomatischer Therapie unter vorsichtiger Blutdrucksenkung und Festlegung des optimalen Entbindungszeitpunkts. Abgewogen werden muss hierbei die fetale Unreife gegen die fetalen und maternalen Risiken bei Prolongation. Der Pathomechanismus des antiangiogenen Overloads mit sFlt-1 liefert einen Ansatz für erste therapeutische Interventionen. Der vorliegende Beitrag gibt einen Überblick in die aktuellen diagnostischen Möglichkeiten und stellt eventuelle Therapieaussichten in der Zukunft zur Diskussion.

Key words

hypertensive diseases of pregnancy - preeclampsia - angiogenic balance

Schlüsselwörter

hypertensive Schwangerschaftserkrankungen - Präeklampsie - angiogene Balance

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