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PATHOGENESIS ANDEARLY DIAGNOSE OF
PRE-ECLAMPSIA
PRESENTED BY
RINA DWI INDRIYANI
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INTRODUCTION
Pre-eclampsia is a multisystem disease,
characterized by new-onset hypertension and
proteinuria after 20 weeks of gestation.
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INTRODUCTION
It is a leading cause of maternal and perinatal
morbidity and mortality worldwide.
The incidence of pre-eclampsia in the United
States are estimated to range between 2-6% of all
cases of pre-eclampsia, 10% for gestational age
less than 34 weeks.
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INTRODUCTION
Global incidence of pre-eclampsia has been
estimated 5-14% of all pregnancies.
In developing countries, the incidence of the
disease was reported 4-18%.
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OBJECTIVE
The purpose of writing this review of literatureis to investigate the pathogenesis and early
detection of pre-eclampsia in order to reduce
morbidity and mortality in women with pre-
eclampsia and know that prevention can be
done in pre-eclampsia.
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Department o f Obstetr ics, Campus Virchow Clin ic,
Charite University Medic ine Berl in, Germany (2012)
pathogenesis associated with angiogenic imbalance.
Circulation ofPlGF (placental growth factor) levels were reduced,
whereas [VEGF (vascular endothelial growth factor) receptor]VEGF-R, sFlt-1 [soluble Flt-1 (fms-like tyrosine kinase-1)], which
increaseD. In placental expression, mRNAand protein of sFlt-1 is
significantly increased.
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Harris Birthright Research Centre for Fetal
Medicine, Kings College Hospital, London, UK
(2010)
in pregnancy with pre-eclampsia maternal
serum concentration of PlGF and PAPP-A is
reduced.
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Department of Obstetrics and Gynaecology, Royal
Womens Hospital, Parkville, Victoria, Australia (2011)
the factors related to the placenta as a
result of oxidative stress.
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Department of Obstetrics and Gynaecology Universidad
de Los Andes, Santiago (2012)
leading to the development of pre-eclampsia can be
explained by the first phase of the invasion TO
trophoblast abnormalities that occur in early pregnancy
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Department of Obstetrics and Gynaecology, Royal
Womens Hospital, Parkville, Victoria, Australia (2011)
effectiveness of most measured uterine artery Doppler in
the second trimester, it demonstrates high sensitivity for
predicting pre-eclampsia, found 29% to be detected.
there were also improvements demonstrate the
effectiveness around first trimester.
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Department of Fetal Medicine, University College
Hospital, London (2013)
several biochemical markers have been proposed for the
initial screening of pre-eclampsia, including maternal
serum or plasma endoglin levels, inhibin-A, activin-A,
Pentraxin-3 and P-selectin were increased, and PAPP-A,PlGF, and placental protein-13, which decreased.
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Department of Fetal Medicine, University College
Hospital, London (2013)
in screening for pre-eclampsia before 34 weeks, the detection rate,
the false positive rate of 10%, about 50% by maternal
characteristics, and this increased to about 90% with the additionof biophysical marker and about 75% with the addition of
biochemical markers. Detection rate increased to over 95% in
screening by an algorithm combining maternal factors, biophysical
and biochemical markers.
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discussion
Department of Obstetrics, Campus Virchow Clinic,Charite University Medicine Berlin, Germany andHarris
Birthright Research Centre for Fetal Medicine, King's
College Hospital, London, UK
Agree about pathogenesis associated with angiogenicimbalance. PlGF levels were reduced, andVEGF-R, sFlt-1
which increases.
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Harris Birthright Research Centre for Fetal Medicine,King's College Hospital, London, UK
also said the same thing that PlGF and PAPP-A is
reduced. This protein is produced by the trophoblast,and reduced concentration reflects impaired
placentation. However, PAPP-A did not remain asignificant predictor than PlGF.
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Department of Obstetrics and Gynaecology, Royal
Women's Hospital, Parkville, Victoria, Australia
said there is a relationship about placenta as a result of
oxidative stress.
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Department of Obstetrics and Gynaecology, Royal Women's
Hospital, Victoria, Australia
said the most effective times for detecting pre-eclampsia by uterine
artery doppler around first trimester.
Department of Obstetrics and Gynecology, St George's University of
London, UK said anything else, early screening for pre-eclampsia
had success with Doppler optimal pregnancy if carried around 24
weeks.
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Department of Fetal Medicine, University College Hospital, London, said several
biochemical markers have been proposed for the initial screening of pre-
eclampsia, which decreased. Biomarker marker is more effective when examined
at 11 13 weeks of gestation
Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital,
University of Bologna, Italy also said the same thing about the biomarkers in
early diagnosis of pre-eclampsia are more effective and sensitive when
performed on a first trimester.
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Harris Birthright Research Centre for Fetal Medicine,King's College Hospital, London, UK and Department of
Fetal Medicine, University College Hospital, London
said that combining biophysical and biochemicalmarkers can detect about 60-90% in the pre eclampsia
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Conclusion
1. The pathogenesis of pre-eclampsia associated with angiogenicimbalance, namely reduced PlGF (placental growth factor) and
VEGF-R as well as an increase in sFlt-1,
2. Early detection of a biochemical or biomarkers can be done with
effective results at gestation weeks 11-13. And early detection
biophysics or uterine artery Doppler performed in the same
week, but it's better at the age of 24 weeks gestation.
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