Preeclampsia & eclampsia
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Preeclampsia & eclampsia
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First Aid
2024
2023
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2021
Abruptio placentae p. 657
preeclampsia p. 660
Autoimmune diseases
preeclampsia and p. 660
Coagulopathy
preeclampsia p. 660
Diabetes mellitus p. 350-358
preeclampsia and p. 660
Hypertension p. 304
preeclampsia p. 660
Magnesium sulfate
preeclampsia/eclampsia p. 660
Placental insufficiency
preeclampsia p. 660
Preeclampsia p. 660
hydatidiform moles p. 656
placental abruption p. 657
Proteinuria p. 613
preeclampsia p. 660
Pulmonary edema
preeclampsia and p. 660
Renal failure
preeclampsia and p. 660
Transcript
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.
In severe preeclampsia, systolic blood pressure can be 160 mmHg or greater and diastolic blood pressure can be 110 mmHg or greater.
These extreme blood pressures can lead to a hemorrhagic stroke or placental abruption, which the placenta detaches prematurely from the uterine wall.
Summary
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.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Hypertension in Pregnancy" Obstetrics & Gynecology (2013)
- "Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis" BMJ (2014)
- "A Comprehensive Review of Hypertension in Pregnancy" Journal of Pregnancy (2012)
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