Severe Preeclampsia

How Deep Should We Dig ?

Gus Dekker, Lyell McEwin Hospital

University of Adelaide

Gus Dekker
 How Deep Should we Dig ?

When a sick pa6ent presents

In order to truly understand and prevent the

disease

To nd underlying disorders

During the post-partum follow up
Gus Dekker
 How Deep Should we Dig ?

When a sick pa6ent presents

In order to truly understand and prevent the

disease

To nd underlying disorders

During the post-partum follow up
Gus Dekker
Gus Dekker
261 of 2023 women with pre-eclampsia had adverse
outcomes at any 6me aHer hospital admission , 106
(5%)within 48 h of admission

Predictors of adverse maternal outcome included
gesta;onal age, chest pain or dyspnoea, oxygen
satura;on,
platelet count, and crea;nine and aspartate transaminase
concentra;ons

The full PIERS model predicted adverse maternal outcomes
within 48 h of study eligibility AUC ROC 088

Full PIERS performed well (AUC ROC >07)
up to 7 days aHer eligibility Gus Dekker
Gus Dekker
with severe upper abdo pain
CT, 39 wks, severe HELLP
Large sub-capsular hematoma
extends over the leH lobe; the
right lobe has heterogeneous,
hypodense appearance
because of widespread
necrosis, with sparing of
the areas of the leH lobe
(compare perfusion with the
normal spleen)
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Seizures not responding to appropriate
treatment
G1P0 induced because
of preeclampsia
BP 140/90, proteinuria,
headache

6 hours post
delivery seizures not
responding to
magnesium
Gus Dekker
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 How Deep Should we Dig ?

When a sick pa6ent presents

In order to truly understand and prevent the

disease

To nd underlying disorders

During the post-partum follow up
Gus Dekker
mother fetus

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 What are the consequences of shallow invasion?

normal invasion defective invasion

Dilation has a surprisingly modest impact on total blood flow (G. Burton!)
Increased velocity of blood flowing into the placenta will:
- damage villous architecture,
- rupture anchoring villi and
- increase peripheral resistance in placental vessels.
Gus Dekker
Burton et al. Placenta 2009
 Preeclampsia A Heterogeneous Syndrome
Phenotypical Dierences - dierent disorders ?

Gus Dekker
 Huppertz, Hypertension 2008, Thromb Res 2011, modified

Origins of Oocyte Sperm

preeclampsia Zygote Dysregulation of
the
and Morula early trophoblast
FGR results in a
Blastocyst
combination of
TrophoblastEmbryoblast Preeclampsia and
FGR
Syncytio- Cytotrophoblast
Dysregulation of
trophoblast Dysregulation of
the extravillous
villous trophoblast trophoblast
villous villous extravillous
results in
ST CT CT results in FGR
Preeclampsia
Maintenance Nutrition of placenta/
of the fetus,
placental Anchoring of theGus Dekker
barrier placenta
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Chris Redman IFPA lecture 2014

Gus Dekker
 What is meant by the term Pre-eclampsia

A syndrome a reversible clinical phenotype; pregnancy induced

hypertension and proteinuria

A syndrome is not a disease it is a situation

Non-specific, likely to be the endpoint of several pathogeneses.

Placenta is causative tissue
Maternal factors can contribute
Concept of two stage disease

Chris Redman

Gus Dekker
 Preeclampsia - a heterogeneous
syndrome
Phenotype spec. pathw. Final common
Lack of remodelling pathway
(IUGR)
Chronic systemic sFlt1/endoglin
inamma;on Debris
Infec;on, e.g CMV
ER stress -
Allosta;c load misfolding
. CKs
Gus Dekker
Gus Dekker
 How Deep Should we Dig ?

When a sick pa6ent presents

In order to truly understand and prevent the

disease

To nd underlying disorders

During the post-partum follow up
Gus Dekker
Gus Dekker
Gus Dekker
Gus Dekker
Gus Dekker
Gus Dekker
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Gus Dekker
 How Deep Should we Dig ?

When a sick pa6ent presents

In order to truly understand and prevent the

disease

To nd underlying disorders

During the post-partum follow up
Gus Dekker
Gus Dekker
Gus Dekker
Gus Dekker
Gus Dekker
Gus Dekker
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Developmental Origins of Adult Diseases

David Barker

Epidemiological studies Gus Dekker

N=33 N=211 N=2061 N=1225
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Maternal Birthweight
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Thank you Happy to take Ques6ons

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