A pregnancy-specific multi-system disorder with unpredictable, variable and widespread manifestations

Aetiology

Risk factors

• Maternal age >40 years
• Maternal BMI >30 years
• Family history
• Parity (more likely in first pregnancy)
• Multiple pregnancy
• Previous PE
• Birth interval >10 years
• Molar pregnancy/triploidy
• Mutiparous women develop more severe disease
• Pre-existing conditions
  • Pre-existing renal disease
  • Pre-existing hypertension
  • Diabetes
  • Connective tissue disease
  • Thrombophilias

Pathophysiology

• Diffuse vascular endothelial dysfunction with widespread circulatory disturbance
• Classified as early or late
  • Early: <34 weeks, uncommon, associated with placental dysfunction
  • Late: ≳34 weeks, accounts for ~9/10 cases
• Stage 1 - abnormal placental perfusion (placental ischaemia)
• Stage 2 - maternal syndrome (an anti-angiogenic state associated with endothelial dysfunction)

Liver disease

• HELLP syndrome - Haemolysis, Elevated Liver enzymes, Low PLatelets