Preeclampsia/Eclampsia

Basics

Description

  • Hypertension in pregnancy:
    • 10% of all pregnancies
    • 10% of maternal deaths
    • Major contributor to prematurity
  • Gestational hypertension (GH):
    • Hypertension associated with pregnancy after 20 wk gestation
    • Resolves with delivery
    • 2–17% of all pregnancies
  • Preeclampsia:
    • GH OR new HTN PLUS proteinuria OR PLUS end-organ damage with or without proteinuria; typically after 20 wks of gestation or postpartum:
      • Hematologic complications (i.e. plt count <150,000, hemolysis, etc)
      • Renal insufficiency: Cr >1.1 mg/dL
      • Impaired liver function: LFTs >2× normal levels
      • Pulmonary edema
      • Neurologic complications (e.g. AMS, blindness, stroke, serve headaches, persistent visual scotomata)
      • Uteroplacental dysfunction (i.e. placental abruption, etc)
    • 4.6% of all pregnancies
    • African American women 3-fold higher rate of maternal mortality rare cases <20 weeks gestation associated with molar preg or APS
  • Eclampsia:
    • Preeclampsia with seizure
  • Postpartum preeclampsia:
    • Occurs within 6 wk of delivery
    • Usually no history of hypertension
    • Occurs in 5% patients
    • 70% present with HA
  • HELLP syndrome:
    • May occur in women with preeclampsia or eclampsia
    • Hemolysis
    • Elevated liver function tests
    • Low platelets
  • Preeclampsia superimposed upon chronic HTN:
    • 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

  • Preeclampsia:
    • Abnormal development of placental vasculature and underperfusion
    • 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
    • Primigravida
    • Multiple gestations
    • Molar pregnancy, hydatidiform mole
    • Smoking
    • Increased body mass index
    • Diabetes, collagen vascular diseases
    • Preexisting hypertension or renal disease
    • History of preeclampsia with prior pregnancies, especially in 2nd trimester (7.5–10% increased risk)
    • Independent risk factors for eclampsia:
      • Nulliparity
      • Maternal age
      • GH

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