Clinical meaning
Abnormal trophoblast invasion of spiral arteries leads to incomplete remodeling and placental ischemia. Ischemic placenta releases anti-angiogenic factors (sFlt-1, sEng) that bind and neutralize VEGF and PlGF, causing systemic endothelial dysfunction. This leads to vasospasm, increased permeability, and end-organ damage. Cerebral vasospasm and posterior reversible encephalopathy syndrome (PRES) underlie seizures.
Diagnosis & workup
Diagnostics & workup: - Order 24-hour urine protein or spot protein-to-creatinine ratio - Order CBC with peripheral smear (rule out HELLP) - Order LFTs, LDH, uric acid for end-organ assessment - Order BMP (creatinine for renal function) - Order coagulation studies for DIC screening - Order sFlt-1/PlGF ratio (emerging predictive biomarker) - Order MRI brain if PRES (posterior reversible encephalopathy syndrome) suspected - Order ophthalmologic exam for papilledema or retinal changes
Risk factors: - Nulliparity - History of preeclampsia - Multiple gestation - Chronic hypertension - Renal disease - Autoimmune disorders - Obesity - Extremes of maternal age (< 20 or > 40) - Family history of preeclampsia