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Preeklampsi og hypertensive svangerskapskomplikasjoner

Sist oppdatert: Sist revidert:
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Definisjon:
Et spekter av tilstander. Preeklampsi er BT ≥ 140 mmHg systolisk og/eller ≥ 90 mmHg diastolisk etter uke 20, ledsaget av proteinuri eller annen organaffeksjon. Kan kompliseres med eklampsi og HELLP
Forekomst:
Rundt 25 per 1000 svangerskap i Norge
Symptomer:
Asymptomatisk eller ved alvorlig preeklampsi hodepine, synsforstyrrelser, uro, magesmerter, raskt økende ødem eller tungpust
Funn:
Forhøyet blodtrykk ved to separate målinger, proteinuri, ev. kraftig vektøkning/ødemer, lave SF-mål, palp. øm øvre hø. kvadrant 
Diagnostikk:
BT og proteinuri undersøkes rutinemessig gjennom svangerskapet. Hb, trombocytter, ASAT, ALAT, LD, urinsyre, kreatinin ved mistanke om preeklampsi 
Behandling:
Fødsel er det eneste som gjør at tilstanden går tilbake. Kan tilsi induksjon av fødsel før termin. Antihypertensiv behandling ved BT > 150/100 mmHg
  • Staff A. et al. Hypertensive svangerskapskomplikasjoner og eklampsi. Norsk gynekologisk forening Veileder i fødselshjelp (2020). ePub. ISBN 978-82-692382-0-4. Siden besøkt 17.09.2021.
  1. Staff A. et al. Hypertensive svangerskapskomplikasjoner og eklampsi. Norsk gynekologisk forening Veileder i fødselshjelp (2020). ePub. ISBN 978-82-692382-0-4. Siden besøkt 16.09.2021. www.legeforeningen.no  
  2. Årstabeller for medisinsk fødselsregister 2019. Fødsler i Norge. Folkehelseinstituttet 2020. Siden besøkt 13.08.2020 statistikkbank.fhi.no  
  3. Harmon QE, Huang L, Umbach DM, et al. Risk of fetal death with preeclampsia. Obstet Gynecol 2015; 125: 628-35. PMID: 25730226 PubMed  
  4. Yang Y, Le Ray I, Zhu J, et al. Preeclampsia Prevalence, Risk Factors, and Pregnancy Outcomes in Sweden and China. JAMA Netw Open 2021; 4: e218401. doi:10.1001/jamanetworkopen.2021.8401 DOI  
  5. Sibai BM, Lockwood CJ, Lindor KD. HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). UpToDate, last updated Aug 2021. Siden besøkt 17.09.21 www.uptodate.com  
  6. Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019 Jul 15;366:l2381. PMID: 31307997.
  7. Mol BW, Roberts CT, Thangaratinam S, et al. Pre-eclampsia. Lancet 2016. Mar 5;387(10022):999-1011. pmid:26342729 PubMed  
  8. Armaly Z, Jadaon JE, Jabbour A, Abassi ZA. Preeclampsia: Novel Mechanisms and Potential Therapeutic Approaches. Front Physiol 2018; 9: 973. pmid:30090069 PubMed  
  9. McGinnis R, Steinthorsdottir V, Williams NO, et al. Variants in the fetal genome near FLT1 are associated with risk of preeclampsia. Nat Genet 2017. pmid:28628106 PubMed  
  10. Milne F, Redman C, Walker J, et al. Assessing the onset of pre-eclampsia in the hospital day unit: summary of the pre-eclampsia guideline (PRECOG II). BMJ 2009; 339: b3129. pmid: 19740933 PubMed  
  11. Chappell LC, Cluver CA, Kingdom J, Tong S. Pre-eclampsia. Seminar. Lancet 2021. doi:10.1016/S0140-6736(20)32335-7 DOI  
  12. Rana S1, Powe CE, Salahuddin S et al. Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation 2012; 125: 911-9. pmid:22261192 PubMed  
  13. Amirian I, Rørbye C, Buron BMD et al. Posterior reversibel encefalopatisk syndrom hos en gravid. Ugeskr Læger 2018; 180: V01180049. ugeskriftet.dk  
  14. Helsedirektoratet. Nasjonal faglig retningslinje for svangerskapsomsorgen. Sist faglig oppdatert: 27.08.2019. www.helsedirektoratet.no  
  15. Toloza FJK, Derakhshan A, Männistö T, et al. Association between maternal thyroid function and risk of gestational hypertension and pre-eclampsia: a systematic review and individual-participant data meta-analysis. Lancet Diabet Endocrinol 2022. pmid:35255260 PubMed  
  16. Storgaard M, Loft A, Bergh C et al. Obstetric and neonatal complications in pregnancies conceived after oocyte donation: a systematic review and meta-analysis. BJOG. 2017 Mar;124(4):561-572. Epub 2016 Sep 5. PMID: 27592694.
  17. Bartsch E, Medcalf KE, Park AL, et al. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ 2016; 353: i1753. pmid: 27094586 PubMed  
  18. NICE guidelines. Hypertension in pregnancy: diagnosis and management. NICE guidelines NG133. Pub: Jun 2019. Siden besøkt: 17.10.19 www.nice.org.uk  
  19. The American College of Obstetricians and Gynecologists' Committee on Practice Bulletins. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol 2019; 133: e1-e25. pmid:30575675 PubMed  
  20. Eastwood KA, Patterson C, Hunter AJ et al. Evaluation of the predictive value of placental vascularisation indices derived from 3-dimensional power Doppler whole placental volume scanning for prediction of pre-eclampsia: a systematic review and meta-analysis. Placenta 2017; 51: 89-97. pmid:28089506 PubMed  
  21. Saffer C, Olson G, Boggess KA et al. Determination of placental growth factor (PlGF) levels in healthy pregnant women without signs or symptoms of preeclampsia. Pregnancy Hypertens 2013; 3: 124-32. pmid:26105949 PubMed  
  22. Duhig KE, Myers J, Seed PT, et al. Placental growth factor testing to assess women with suspected pre-eclampsia: a multicentre, pragmatic, stepped-wedge cluster-randomised controlled trial. Lancet 2019. pmid:30948284 PubMed  
  23. Nielsen LH, Sundtoft I, Vestgaard MJ et al. Hypertension og præeklampsi. Danske Selskab for Obstetrik og Gynækologi. Obstetrisk Guideline 2018. www.dsog.dk  
  24. Bramham K, Parnell B, Nelson-Piercy C, et al. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014 ;348:g2301. pmid: 24735917 PubMed  
  25. Magro-Malosso ER, Saccone G, Di Tommaso M et al. Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2017; 96: 921-31. pmid:28401531 PubMed  
  26. McCall CA, Grimes DA, Lyerly AD. "Therapeutic" bed rest in pregnancy: unethical and unsupported by data. Obstet Gynecol. 2013 Jun;121(6):1305-1308. PMID: 23812466.
  27. Palmer KT, Bonzini M, Harris EC et al. Work activities and risk of prematurity, low birth weight and pre-eclampsia: an updated review with meta-analysis. Occup Environ Med 2013; 70: 213-22. pmid:23343859 PubMed  
  28. Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega‐3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD003402. DOI: 10.1002/14651858.CD003402.pub3. DOI  
  29. Bezerra Maia E Holanda Moura S, Marques Lopes L, Murthi P et al. Prevention of preeclampsia. J Pregnancy 2012; epub: 435090. pmid:23316362 PubMed  
  30. McCance DR, Holmes VA, Maresh MJA, et al. Vitamins C and E for prevention of pre-eclampsia in women with type 1 diabetes (DAPIT): a randomised placebo-controlled trial. Lancet 2010; 376: 259-66. PubMed  
  31. Bone JN, Sandhu A, Abalos ED, et al. Oral Antihypertensives for Nonsevere Pregnancy Hypertension: Systematic Review, Network Meta- and Trial Sequential Analyses. Hypertension 2022; 79: 614-628. pmid:35138877 PubMed  
  32. Tita AT, Szychowski JM, Boggess K et al. Chronic Hypertension and Pregnancy (CHAP) Trial Consortium. Treatment for Mild Chronic Hypertension during Pregnancy. N Engl J Med. 2022 Apr 2. Epub ahead of print. PMID: 35363951.
  33. Abalos E, Duley L, Steyn DW, Gialdini C. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD002252. DOI: 10.1002/14651858.CD002252.pub4. DOI  
  34. Duley L, Henderson-Smart DJ, Meher S. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD001449. DOI: 10.1002/14651858.CD001449.pub3 DOI  
  35. Berhan Y, Berhan A. Should magnesium sulfate be administered to women with mild pre-eclampsia? A systematic review of published reports on eclampsia. J Obstet Gynaecol Res. 2015 Jun;41(6):831-42. pmid: 25833188 PubMed  
  36. Duley L, Gülmezoglu AM, Henderson‐Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre‐eclampsia. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD000025. DOI: 10.1002/14651858.CD000025.pub2. The Cochrane Library  
  37. Churchill D, Duley L, Thornton JG, Moussa M, Ali HSM, Walker KF. Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD003106. DOI: 10.1002/14651858.CD003106.pub3 DOI  
  38. Chappell LC, Brocklehurst P, Green ME et al. PHOENIX Study Group. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet. 2019 Sep 28;394(10204):1181-1190. Epub 2019 Aug 28. PMID: 31472930 PubMed  
  39. Cluver C, Novikova N, Koopmans CM, West HM. Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No.: CD009273. DOI: 10.1002/14651858.CD009273.pub2. DOI  
  40. Koopmans CM, Bijlenga D, Groen H, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' getsation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet 2009; 374: 979-88. PubMed  
  41. Amorim MMR, Souza ASR, Katz L. Planned caesarean section versus planned vaginal birth for severe pre‐eclampsia. Cochrane Database of Systematic Reviews 2017, Issue 10. Art. No.: CD009430. DOI: 10.1002/14651858.CD009430.pub2. DOI  
  42. Magee LA, Nicolaides KH, von Dadelszen P. Preeclampsia. N Engl J Med. 2022 May 12;386(19):1817-1832. PMID: 35544388 PubMed  
  43. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med 2017. PMID: 28657417 PubMed  
  44. Henderson JT, Whitlock EP, O'Connor E, et al. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: A systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 160: 695-703. pmid: 24711050 PubMed  
  45. Duley L, Meher S, Hunter KE, Seidler AL, Askie LM. Antiplatelet agents for preventing pre‐eclampsia and its complications. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD004659. DOI: 10.1002/14651858.CD004659.pub3. The Cochrane Library  
  46. US Preventive Services Task Force. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality US Preventive Services Task Force Recommendation Statement. JAMA 2021; 326: 1186-91. pmid:34581729 PubMed  
  47. Hofmeyr GJ, Manyame S, Medley N, Williams MJ. Calcium supplementation commencing before or early in pregnancy, for preventing hypertensive disorders of pregnancy. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD011192. DOI: 10.1002/14651858.CD011192.pub3. The Cochrane Library  
  48. Rumbold A, Ota E, Hori H, Miyazaki C, Crowther CA. Vitamin E supplementation in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD004069. DOI: 10.1002/14651858.CD004069.pub3. The Cochrane Library  
  49. Rumbold A, Ota E, Nagata C, Shahrook S, Crowther CA. Vitamin C supplementation in pregnancy. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD004072. DOI: 10.1002/14651858.CD004072.pub3. The Cochrane Library  
  50. Poon LC, Shennan A, Hyett JA et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet 2019; 145: 1-33. pmid:31111484 PubMed  
  51. Skjaerven R, Wilcox AJ, Klungsøyr K, et al. Cardiovascular mortality after pre-eclampsia in one child mothers: prospective, population based cohort study. BMJ 2012; 345: e7677. pmid: 23186909 PubMed  
  52. Brown MC, Best KE, Pearce MS et al. Cardiovascular disease risk in women with pre‐eclampsia: Systematic review and meta‐analysis. Eur J Epidemiol 2013; 28: 1-19. pmid:23397514 PubMed  
  53. Kessous R, Shoham-Vardi I, Pariente G et al. Long-term maternal atherosclerotic morbidity in women with pre-eclampsia. Heart 2015; 101: 442-6. pmid:25564558 PubMed  
  54. Stuart JJ, Tanz LJ, Missmer SA et al. Hypertensive Disorders of Pregnancy and Maternal Cardiovascular Disease Risk Factor Development: An Observational Cohort Study. Ann Intern Med 2018; 169: 224-32. pmid:29971437 PubMed  
  55. Brown MA, Magee LA, Kenny LC et al. International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension. 2018 Jul;72(1):24-43. PMID: 29899139. PubMed  
  • Silje Folven Barlindhaug, spesialist i allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Kjell Åsmund Salvesen, overlege Kvinneklinikken St. Olavs hospital. Professor i fødselshjelp og kvinnesykdommer, NTNU