### Date : 2024-09-03 21:12 ### Topic : Preeclampsia #OBGY #medicine ---- ### **Preeclampsia Overview** **Preeclampsia** is a serious pregnancy complication characterized by high blood pressure and often proteinuria (excess protein in the urine) that develops after 20 weeks of gestation. It can affect multiple organ systems and, if left untreated, can progress to eclampsia, a life-threatening condition involving seizures. ### **Epidemiology** - Preeclampsia occurs in about 5-8% of pregnancies. - It is a leading cause of maternal and perinatal morbidity and mortality worldwide. ### **Risk Factors** - **First Pregnancy**: Preeclampsia is more common in women who are pregnant for the first time. - **History of Preeclampsia**: Women who had preeclampsia in a previous pregnancy are at increased risk. - **Chronic Hypertension**: Preexisting high blood pressure increases the likelihood of developing preeclampsia. - **Multiple Gestations**: Women carrying twins, triplets, or more are at higher risk. - **Maternal Age**: Women younger than 20 or older than 35 have a higher risk. - **Obesity**: Higher body mass index (BMI) is associated with an increased risk of preeclampsia. - **Diabetes or Kidney Disease**: Preexisting conditions like diabetes or kidney disease can increase the risk. - **Family History**: A family history of preeclampsia increases the likelihood of developing the condition. - **Autoimmune Diseases**: Conditions like lupus or antiphospholipid syndrome increase the risk. ### **Pathophysiology** Preeclampsia is believed to originate from abnormal placentation (the development of the placenta) in early pregnancy. This leads to: - **Endothelial Dysfunction**: The lining of blood vessels is damaged, resulting in vasoconstriction, increased blood pressure, and reduced blood flow to various organs. - **Increased Vascular Permeability**: Leads to proteinuria and edema. - **Coagulation Abnormalities**: Increased clotting tendencies can lead to complications like HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). ### **Clinical Features** 1. **Hypertension**: - Defined as a systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg on two occasions at least four hours apart after 20 weeks of gestation. 2. **Proteinuria**: - **Diagnostic Criterion**: Proteinuria is typically defined as ≥300 mg of protein in a 24-hour urine collection or a protein/creatinine ratio ≥0.3, or a dipstick reading of 1+ or greater. 3. **Edema**: - Swelling, particularly in the hands, face, and lower extremities, is common but not required for diagnosis. 4. **Other Symptoms**: - **Severe Headache**: Persistent and often refractory to typical pain relievers. - **Visual Disturbances**: Blurred vision, seeing spots or flashing lights, or temporary loss of vision. - **Epigastric Pain**: Pain in the upper abdomen, often a sign of liver involvement. - **Nausea or Vomiting**: Particularly in cases where liver involvement is significant. - **Oliguria**: Reduced urine output, indicating possible kidney involvement. - **Hyperreflexia**: Increased deep tendon reflexes, which can be a precursor to eclampsia. ### **Diagnosis** - **Blood Pressure Measurement**: Consistently elevated readings ≥140/90 mmHg. - **Urine Tests**: To confirm proteinuria. - **Blood Tests**: - **Complete Blood Count (CBC)**: To check for hemolysis and low platelets. - **Liver Function Tests (LFTs)**: Elevated enzymes indicate liver involvement. - **Renal Function Tests**: Elevated creatinine levels suggest kidney involvement. - **Fetal Monitoring**: Non-stress tests, ultrasound, and biophysical profiles to assess fetal well-being. ### **Management** The primary goal in managing preeclampsia is to prevent the progression to eclampsia and to ensure the safety of both mother and baby. Management depends on the severity of the condition and the gestational age. 1. **Mild Preeclampsia**: - **Expectant Management**: For mild cases close to term (≥37 weeks), delivery is usually recommended. If the pregnancy is preterm, careful monitoring of the mother and fetus is essential. - **Blood Pressure Monitoring**: Regular checks at home or in a clinical setting. - **Fetal Monitoring**: Regular ultrasound and non-stress tests. - **Lifestyle Modifications**: Bed rest may be recommended, though it is controversial and should be balanced with the risks of immobility. 2. **Severe Preeclampsia**: - **Hospitalization**: Required for close monitoring and treatment. - **Antihypertensive Therapy**: Medications like labetalol, hydralazine, or nifedipine are used to control severe hypertension. - **Corticosteroids**: Administered to enhance fetal lung maturity if the pregnancy is preterm (24-34 weeks gestation). - **Magnesium Sulfate**: Administered to prevent seizures (eclampsia). - **Timing of Delivery**: In cases of severe preeclampsia, delivery is often recommended, regardless of gestational age, if the condition is worsening or there are signs of fetal distress. 3. **Postpartum Management**: - **Continued Monitoring**: Blood pressure and symptoms are closely monitored postpartum, as preeclampsia can persist or worsen after delivery. - **Medication**: Antihypertensive medications may be continued postpartum. ### **Complications** 1. **Eclampsia**: The onset of seizures in a woman with preeclampsia, a life-threatening emergency. 2. **HELLP Syndrome**: A severe form of preeclampsia with Hemolysis, Elevated Liver enzymes, and Low Platelets. It can lead to serious complications for both the mother and baby. 3. **[[Placental Abruption]]**: The premature separation of the placenta from the uterus, which can cause severe bleeding and fetal distress. 4. **Stroke**: Due to severe hypertension, increasing the risk of cerebral hemorrhage. 5. **Kidney Damage**: Acute kidney injury can occur due to reduced blood flow and high blood pressure. 6. **Liver Damage**: Liver dysfunction or rupture can occur in severe cases. 7. **Fetal Complications**: - **Preterm Birth**: The most significant risk, often necessary due to the severity of the maternal condition. - **Intrauterine Growth Restriction (IUGR)**: Due to placental insufficiency, the baby may not grow as expected. - **Stillbirth**: Severe cases of preeclampsia can lead to fetal demise. ### **Prognosis** - **Maternal Prognosis**: With timely diagnosis and appropriate management, most women recover fully after delivery. However, there is an increased risk of future cardiovascular disease and preeclampsia in subsequent pregnancies. - **Fetal Prognosis**: Depends largely on gestational age at the time of delivery and the severity of the maternal condition. Preterm infants may face complications related to prematurity. ### **Prevention** 1. **Antenatal Care**: Regular prenatal visits are crucial for early detection of preeclampsia. 2. **Low-Dose Aspirin**: For women at high risk of preeclampsia, low-dose aspirin (81 mg) starting late in the first trimester may reduce the risk. 3. **Calcium Supplementation**: Recommended in populations with low dietary calcium intake to reduce the risk of preeclampsia. 4. **Lifestyle Modifications**: Healthy diet, regular exercise, and maintaining a healthy weight before and during pregnancy can help reduce the risk. Preeclampsia is a serious condition that requires careful monitoring and management to prevent complications. Early detection through regular prenatal care is essential to ensure the best possible outcomes for both the mother and the baby. ### Reference: - ### Connected Documents: -