Good clinical practice advice: First trimester screening and prevention of pre‐eclampsia in singleton pregnancy

Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. Globally, this condition is associated with 80 000 maternal and more than 500 000 infant deaths annually.1 Evidence suggests that preeclampsia can be further subdivided into preterm preeclampsia, with delivery before 37 weeks’ gestation, and term preeclampsia, with delivery at 37 weeks or later.2 Preterm preeclampsia is associated with a higher incidence of fetal growth restriction and both shortterm and longterm maternal and perinatal mortality and morbidity.3,4 Obstetricians managing cases of preterm preeclampsia are faced with the challenge of balancing the need for achievement of fetal maturation with the risks to mother and fetus from continuing pregnancy. For the mother, shortterm risks include progression to placental abruption, HELLP syndrome (a group of signs in pregnant women including hemolysis, elevated liver enzymes, and low platelet count), eclampsia, cerebrovascular accident, and death.3 Additionally, the condition is associated with an increased risk of death from future cardiovascular disease, hypertension, stroke, and diabetes, and the life expectancy of women affected by preterm preeclampsia is reduced on average by 10 years.5 For the fetus, preterm delivery is, in itself, associated with higher mortality rates and increased morbidity resulting from thrombocytopenia, bronchopulmonary dysplasia, cerebral palsy, and an increased risk of various chronic diseases in adulthood.6 There are major cost implications for management of women with preeclampsia and their babies, especially when the condition is severe and associated with fetal growth restriction.7,8