Preeclampsia/eclampsia
To view the entire topic, please log in or purchase a subscription.
Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
-- The first section of this topic is shown below --
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
- 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
- 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
-- To view the remaining sections of this topic, please log in or purchase a subscription --
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
- 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
- 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
There's more to see -- the rest of this topic is available only to subscribers.