Preeclampsia/eclampsia

Preeclampsia/eclampsia is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Hypertension in pregnancy:
    • 1% of all pregnancies
    • 16% of maternal deaths
  • Gestational hypertension (GH)
    • Hypertension associated with pregnancy
    • Resolves with delivery
    • 6–7% of all pregnancies
  • Preeclampsia
    • GH PLUS proteinuria
    • 2.2–6.3% of all pregnancies
  • 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

  • Preeclampsia
    • Incomplete placental implantation and underperfusion
    • Leads to decreased angiogenic growth factor and increased maternal placental debris in circulation
  • 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 (7.5–10% increased risk)
    • Independent risk factors for eclampsia
      • Nulliparity
      • Maternal age
      • GH

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