Preeclampsia/eclampsia
Basics
Description
Description
- Hypertension in pregnancy:
- 10% of all pregnancies
- 7.4% of maternal deaths
- Major contributor to prematurity
- Gestational hypertension (GH):
- Hypertension associated with pregnancy after 20 wk gestation
- Resolves with delivery
- 6–17% of all pregnancies
- Preeclampsia:
- GH PLUS proteinuria OR GH PLUS end-organ damage:
- Thrombocytopenia: Plt <100,000/microL
- Renal insufficiency: Cr >1.1 mg/dL
- Impaired liver function: LFTs >2× normal levels
- Pulmonary edema
- Cerebral or visual symptoms
- 4.6% of all pregnancies
- GH PLUS proteinuria OR GH PLUS end-organ damage:
- Eclampsia:
- Preeclampsia with seizure
- Postpartum preeclampsia:
- Occurs within 6 wk of delivery
- Usually no history of hypertension
- Occurs in 5% patients
- Most women are African American
- HELLP syndrome:
- May occur in women with preeclampsia or eclampsia
- Hemolysis
- Elevated liver function tests
- Low platelets
- Superimposed preeclampsia:
- Preeclampsia in the setting of chronic hypertension
- Complicates pregnancy in up to 25% of women with chronic hypertension
- Risk factors:
- African American
- Antihypertensive medication use
- Chronic hypertension:
- Systolic BP (SBP) >140 or diastolic BP (DBP) >90
- Measured twice prior to 20 wk gestation or lasting >12 wk after delivery
Etiology
Etiology
- Preeclampsia:
- Incomplete placental implantation and under perfusion
- Leads to decreased angiogenic growth factor and increased maternal placental debris in circulation
- Causes increased dysfunction in maternal vascular system
- Eclampsia:
- 1/3 of patients with eclampsia did not have hypertension prior to seizure
- Risk factors:
- Extremes of reproductive age
- Primagravida
- Multiple gestations
- Molar pregnancy, hydatidiform mole
- Smoking
- Increased body mass index
- Diabetes, collagen vascular diseases
- Pre-existing hypertension or renal disease
- History of preeclampsia with prior pregnancies, especially in second trimester (7.5–10% increased risk)
- Independent risk factors for eclampsia:
- Nulliparity
- Maternal age
- GH
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Citation
Schaider, Jeffrey J., et al., editors. "Preeclampsia/eclampsia." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307085/2.2/Preeclampsia_eclampsia.
Preeclampsia/eclampsia. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307085/2.2/Preeclampsia_eclampsia. Accessed November 8, 2024.
Preeclampsia/eclampsia. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307085/2.2/Preeclampsia_eclampsia
Preeclampsia/eclampsia [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 November 08]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307085/2.2/Preeclampsia_eclampsia.
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