Preeclampsia/eclampsia

Basics

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
  • 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 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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