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Pathophysiology and pregnancy outcomes of ascites in preeclampsia—a scoping review

Journal of Human Hypertension volume 38, pages 631–641 (2024)Cite this article

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Abstract

Preeclampsia is a multisystem disorder associated with defective trophoblast invasion, maternal syndrome, and capillary endothelial leak. The presence of ascites/third space fluid accumulation increases the risk of maternal morbidity and mortality. The current criteria/guidelines of preeclampsia do not establish the presence of ascites as a marker of severity or recognize the timing and need for early delivery despite associated complications. Medline and Embase databases were searched to identify relevant literature, reported up to December 2023, regarding the pathophysiology, pregnancy outcome, and management of preeclampsia complicated with ascites. A total of 5 studies on pathophysiology and eight on pregnancy outcomes met the inclusion criteria, with 41 case reports on ascites in preeclampsia. The etiopathogenesis for the development of ascites in preeclampsia includes endothelial damage, capillary hyperpermeability, release of vasoconstrictive agents, reduced intravascular oncotic pressure, and raised intraabdominal pressure. The presence of ascites represents the extreme form of microvascular damage, which also correlates with the raised sFlt-1 levels in this condition. The adverse pregnancy outcomes include increased risk of congestive heart failure, eclampsia, renal failure, disseminated intravascular coagulation, acute respiratory distress syndrome, and maternal death. The presence of ascites in preeclampsia is associated with the deterioration of the maternal condition. Hence, it is indicative of preeclampsia with severe features and requires vigilant monitoring, and prompt delivery may be considered.

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Fig. 1
Fig. 2: Methods for diagnosing ascites in pregnancy.
Fig. 3: Pathophysiology of ascites in preeclampsia.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author. Protocol Registration: the protocol as registered in the PROSPERO registry (registration number CRD42023484316 and is accessible at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023484316).

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Madurai, India

    Yavana Suriya Venkatesh

  2. Department of Cardiology, Thoothukudi Medical College, Thoothukudi, India

    Venkatesh Raju

  3. Department of Interventional Radiology, MD Anderson Cancer Centre, Houston, TX, USA

    Koustav Pal

  4. Department of Obstetrics and Gynaecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India

    Anish Keepanasseril

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YSV and AK conceived the study. All authors contributed to the design. KP searched the databases. AK and YSV performed the screening. YSV and VR extracted the details from each study. and guarantees data integrity. VR, YSV, and AK wrote the first draft. All authors contributed to the revising and finalization of the manuscript. AK (corresponding author) guarantees all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Correspondence to Anish Keepanasseril.

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Venkatesh, Y.S., Raju, V., Pal, K. et al. Pathophysiology and pregnancy outcomes of ascites in preeclampsia—a scoping review. J Hum Hypertens 38, 631–641 (2024). https://doi.org/10.1038/s41371-024-00927-0

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