Preeclampsia in Pregnancy: Pathological Mechanisms, Risk Stratification, and Evidence-Based Prevention Strategies
Keywords:
preeclampsia, placental dysfunction, sFlt-1, angiogenesis, aspirin prophylaxis, hypertensive disorders of pregnancy, first-trimester screeningAbstract
Preeclampsia is a hypertensive disorder of pregnancy affecting approximately 5–8% of all gestations worldwide and constitutes one of the leading causes of maternal and perinatal morbidity and mortality. Its pathogenesis is rooted in defective placentation, characterized by shallow cytotrophoblast invasion, impaired spiral artery remodeling, and subsequent placental ischemia. This triggers a systemic inflammatory cascade and endothelial dysfunction mediated predominantly by the antiangiogenic factor sFlt-1 and reduced placental growth factor (PlGF). Early identification of at-risk women through validated first-trimester combined screening—incorporating maternal history, mean arterial pressure, uterine artery Doppler, and serum biomarkers—has transformed clinical management. Evidence-based preventive interventions, chiefly low-dose aspirin initiated before 16 weeks and calcium supplementation in deficient populations, demonstrate significant risk reduction. This review synthesizes current knowledge on preeclampsia pathophysiology, diagnostic criteria, risk stratification tools, and pharmacological and non-pharmacological prevention, providing an integrated framework for contemporary obstetric practice.
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