Pre-eclampsia overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

Preeclampsia is one of the leading causes of maternal and perinatal mortality worldwide and is defined as new-onset hypertension after 20 weeks of gestation or near the term accompanied by proteinuria or other [[maternal] organ involvement.Right upper quadrant or epigastric pain may be due to periportal and focal parenchymal necrosis, hepatic cell edema, or Glisson’s capsule distension.

periportal and focal parenchymal necrosis, hepatic cell edema, or Glisson’s capsule distension, or a combination. However reeclampsia is gestational hypertension accompanied by ≥1 of the following new-onset conditions at or after 20 weeks’ gestation:  Proteinuria  Other maternal organ dysfunction, including:   AKI (creatinine ≥90umol/L; 1 mg/dL)   Liver involvement (elevated transaminases, eg, alanine aminotransferase or aspartate aminotransferase >40 IU/L) with or without right upper quadrant or epigastric abdominal pain   Neurological complications (examples include eclampsia, altered mental status, blindness, stroke, clonus, severe headaches, and persistent visual scotomata)   Hematological complications (thrombocytopenia–platelet count <150 000/μL, disseminated intravascular coagulation, hemolysis)  Uteroplacental dysfunction (such as fetal growth restriction, abnormal umbilical artery [UA] Doppler wave form analysis, or stillbirth)

Pre-eclampsia (US: preeclampsia) is a medical condition where hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant protein in the urine. Its cause remains unclear, although the principal cause appears to be a substance or substances from the placenta causing endothelial dysfunction in the maternal blood vessels. While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium and kidneys and liver, with the release of vasopressive factors only secondary to the original damage.

Diagnosis

Physical Examination

Pre-eclampsia is diagnosed when a pregnant woman develops high blood pressure (two separate readings taken at least 6 hours apart of 140/90 or more). A rise in baseline BP of 20 systolic or 15 diastolic, while not meeting the absolute criteria of 140/90 is still considered important to note but no longer diagnostic. Swelling, or edema, (especially in the hands and face) was originally considered an important sign for a diagnosis of pre-eclampsia, but in current medical practice, only hypertension and proteinuria are necessary for a diagnosis. However, unusual swelling, particularly of the hands, feet, or face, notable by leaving an indentation when pressed on, can be significant and should be reported to the health-care provider.

Laboratory Findings

A finding of 300 mg of protein in a 24-hour urine sample (proteinuria) is necessary for a diagnosis of pre-eclampsia. Some women develop high blood pressure without the proteinuria (protein in urine); this is called pregnancy-induced hypertension (PIH) or gestational hypertension. Both pre-eclampsia and PIH are regarded as very serious conditions and require careful monitoring of mother and baby.

References