by email@example.com (322 Posts), Tue Jul 24, 2007 00:09 am
For women with severe pre-eclampsia (eclampsia would thus qualify), early-onset pre-eclampsia (onset before 34 weeks), or pre-eclampsia associated with a perinatal loss (stillbirth or neonatal death), the recurrence risk is in the order of 40% in a later pregnancy. However, this recurrence, if it occurs, is likely to be milder and of later onset than on the first occasion.
I would suggest that Deb seek risk stratification once she is pregnant again (having used folate prior to conception). By this I mean a first trimester PAPP-A (low conferring increased risk), and second trimester HCG and AFP (high of either or both conferring increased risk), and uterine artery Doppler studies (High resistance or presence of 'notching' conferring increased risk). The corollary is that if these are all normal, then her recurrence risk is <10%.
Through this means, she may be able to be reassured or, if not, be provided with increased surveillance for the remainder of the pregnancy (+/- rest at home). The new Canadian guidelines for the hypertensive disorders of pregnancy will discuss this in some detail - they should be published before the end of this calendar year (2007) in the Journal of Obstetrics and Gynaecology Canada.