A new pathophysiological concept and new classification of pre-eclampsia

The first description of eclampsia (E) was given by Hippocrates, a father of modern medicine (460-377 BC), a son of Heraclides from the island of Kos . After more than two millennia since the first descriptions, the syndrome of preeclampsia/eclampsia (PE/E) has remained a multi-system disorder of unknown etiology. The diagnosis is based on a clinical picture and laboratory analysis; an efficient prevention and screening are missing, the therapy is symptomatic, while giving birth still remains the only causal therapy. Hypertensive disease in pregnancy (HDP) implies various clinical entities with hypertension being the common one. Thirty-one epidemiological studies have been published in the period from 1979 to 2013 with the incidence of PE on the global level in five different regions of the World Health Organisation and in 29 countries amounting to 2.16%, while the incidence of E amounts to 0.28% . In Europe, more than 90% of deaths of mothers caused by PE/E could have been avoided 3, . Pregnant women having PE/E have a greater incidence of induced births, C-sections and preterm births . In women with E, an exponential risk growth for death or high threat to the life of the pregnant woman, fetal death, neonatal death, perinatal death and reception to the neonatal intensive care unit has been detected . Why is the problem still significant? The PE incidence has grown by 25% in some of the developed Western world countries . Another major reason is the estimate that every year 50,000–60,000 women in the world die from PE and its complications 6, . For each of these deaths one must add 50– 100 pregnant women whose life is threatened due to PE/E 8, . PE represents a major reason of iatrogenic prematurity while the last but not the least important reason is that PE has been recognised as a serious risk factor for the appearance of cardiovascular and metabolic diseases in the later life of the woman and her new-born 10, .