Preeclampsia & eclampsia

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Preeclampsia & eclampsia

Reproductive system


Preeclampsia & eclampsia


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Preeclampsia & eclampsia

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USMLE® Step 1 style questions USMLE

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A 37-year-old woman, gravida 1 para 0, comes to the office for a routine prenatal appointment at 28 weeks of gestation. The pregnancy has been uneventful, and she has been compliant with prenatal care. During the past week, she has been feeling a severe throbbing headache, with minimal response to acetaminophen. Medical history is unremarkable, and she has no history of migraines. Temperature is 37.0°C (98.6°F), pulse is 95/min, and blood pressure is 150/95 mmHg. Review of medical records at 24 weeks of gestation shows blood pressure of 135/80. Which of the following would prompt further evaluation in this patient?  

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Abruptio placentae p. 664

preeclampsia p. 667

Autoimmune diseases

preeclampsia and p. 667


preeclampsia p. 667

Diabetes mellitus p. 352-360

preeclampsia and p. 667

Hypertension p. 306

preeclampsia p. 667

Magnesium sulfate

preeclampsia/eclampsia p. 667

Placental insufficiency

preeclampsia p. 667

Preeclampsia p. 667

hydatidiform moles p. 663

placental abruption p. 664

Proteinuria p. 619

preeclampsia p. 667

Pulmonary edema

preeclampsia and p. 667

Renal failure

preeclampsia and p. 667


Preeclampsia is a disorder that only happens in pregnant women, and it happens after 20 weeks’ gestation, and in some cases develops up to 6 weeks after delivery.

Preeclampsia causes new-onset hypertension and proteinuria, which is a marker of kidney damage, and can also cause damage to other organs like the brain and liver.

There can be a wide range of symptoms. For some women there may be no symptoms or only mild ones, whereas for others, it can turn into a life-threatening illness.

If a woman with preeclampsia develops seizures, she is then said to have eclampsia.

Preeclampsia tends to occur more often during a first pregnancy, in pregnancies with multiple gestations, or in mothers 35 years or older.

Other risk factors include having hypertension, diabetes, obesity, or a family history of preeclampsia.

Alright, but why do these changes happen in preeclampsia and eclampsia?

Well, the exact cause is unclear, but a key pathophysiologic feature though is the development of an abnormal placenta.

Normally, during pregnancy, the spiral arteries dilate to 5-10 times their normal size and develop into large uteroplacental arteries that can deliver large quantities of blood to the developing fetus.

In preeclampsia, these uteroplacental arteries become fibrous causing them to narrow, which means less blood gets to the placenta.

A poorly perfused placenta can lead to intrauterine growth restriction and even fetal death in severe cases.

This hypoperfused placenta starts releasing pro-inflammatory proteins.

These then get into the mother’s circulation and cause the endothelial cells that line her blood vessels to become dysfunctional.

Endothelial cell dysfunction causes vasoconstriction—narrowing of the blood vessels—and also affects the kidneys in a way that makes them retain more salt, both of which result in hypertension.

When diagnosing preeclampsia, hypertension is defined as a systolic blood pressure of 140 mmHg or greater or diastolic blood pressure of 90 mmHg or greater.


Preeclampsia and eclampsia are two separate, but related, conditions that occur during pregnancy. Preeclampsia is characterized by hypertension and proteinuria presenting after 20 weeks of gestation and can worsen over time. In severe disease, there may be hemolysis, a low blood platelet count, impaired liver function, kidney dysfunction, shortness of breath due to fluid in the lungs, and visual disturbances.

If left untreated, preeclampsia can lead to eclampsia, a more serious condition in which the woman experiences convulsions or seizures. Treatment for preeclampsia and eclampsia typically involves a combination of bed rest and medications such as antihypertensives and magnesium sulfate, which helps to prevent seizures. In some cases, the delivery of the baby may be required.


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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Hypertension in Pregnancy" Obstetrics & Gynecology (2013)
  6. "Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis" BMJ (2014)
  7. "A Comprehensive Review of Hypertension in Pregnancy" Journal of Pregnancy (2012)

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