Preeclampsia is a pregnancy-specifi...

Preeclampsia is a pregnancy-specific, multisystem disorder that is characterized from the development of hypertension and proteinuria after 20 weeks of gestation. The disorder complicates approximately 5 to 7 percent of pregnancies, (1) with an incidence of 236 cases for 1,000 deliveries in the United States. (2)

Complications of hypertension are the third leading cause of pregnancy-related deaths, supersed merely by hemorrhage and embolism. (3) Preeclampsia is associated with increased risks of placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular coagulation, and maternal death. (3) Consequently early diagnosis of preeclampsia and obstruct observation are imperative.

Diagnosis

Diagnostic criteria for preeclampsia include of recent origin onset of elevated blood urgency and proteinuria after 20 weeks of gestation. Features so as edema and blood urgency elevation above the patient's baseline no longer are diagnostic criteria. (45) unrelenting preeclampsia is indicated by more substantial kin pressure elevations and a greater step of proteinuria. Other features of cruel preeclampsia include oliguria, cerebral or visual disturbances, and pulmonary edema or cyanosis (Table 1) (45)

Diagnosis becomes les difficult if physicians understand where preeclampsia "fits" into the hypertensive disorders of pregnancy. These disorders include chronic hypertension, preeclampsia-eclampsia, preeclampsia superimposed upon chronic hypertension, and gestational hypertension (Figure 1) (5)

[FIGURE 1 OMITTED]

Chronic hypertension is defined by the agency of elevated blood pressure that predates the pregnancy, is documented before 20 weeks of gestation, or is quick in emergencies 12 weeks after delivery. (5) In contrast, preeclampsia-eclampsia is defined by way of elevated blood pressure and proteinuria that be met with after 20 weeks of gestation. Eclampsia, a stern complication of preeclampsia, is the fresh onset of seizures in a woman with preeclampsia. Eclamptic seizures are relatively rare and happen in less than 1 percent of women with preeclampsia. (1)

Preeclampsia superimposed onward chronic hypertension is characterized from new-onset proteinuria (or by a unexpected increase in the protein flat if proteinuria already is present) an acute increase in the plain of hypertension (assuming proteinuria already exists), or disclosure of the HELLP (hemolysis, elevated liver enzyme grave platelet count) syndrome. (4)

Gestational hypertension is diagnosed when elevated vital current pressure without proteinuria develops after 20 weeks of gestation and life-current pressure returns to normal within 12 weeks after delivery. (4) single fourth of women with gestational hypertension bring to maturity proteinuria and thus progress to preeclampsia. (67)

Risk Factors

Risk factors for preeclampsia include medical conditions with the potential to cause microvascular disease (eg diabetes mellitus, chronic hypertension, vascular and connective tissue disorders), antiphospholipid antibody syndrome and nephropathy. (48) Other risk factors are associated with pregnancy itself or may be specific to the mother or father of the fetus (Table 2) (48)

Pathophysiology

Although the exact cause of preeclampsia remains unclear, (45) many theories center upon problems of placental implantation and the flat of trophoblastic invasion. (9,10) It is important to remember that although hypertension and proteinuria are the diagnostic criteria for preeclampsia, they are alone symptoms of the pathophysiologic changes that be met with in the disorder. One of the mostly striking physiologic changes is intense systemic vasospasm, which is responsible for decreased perfusion of virtually all organ regularitys (11) Perfusion also is diminished because of vascular hemoconcentration and third spacing of intravascular fluids. In addition, preeclampsia is accompanied from an exaggerated inflammatory response and inappropriate endothelial activation. (10) Activation of the coagulation cascade and resultant microthrombi formation further compromise posterity flow to organs. (11)

Clinical Presentation

The clinical presentation of preeclampsia may be insidious or fulminant. one women may be asymptomatic at the time they are build to have hypertension and proteinuria; others may not away with symptoms of severe preeclampsia, like as visual disturbances, severe headache, or upper abdominal pain. From 4 to 14 percent of women with preeclampsia existing with superimposed HELLP syndrome. (12) HELLP syndrome may be a variant of preeclampsia or a separate entity, nevertheless its development is ominous because mortality or serious morbidity appears in 25 percent of affected women (13)

Preeclampsia-eclampsia may unravel before, during, or after delivery. Up to 40 percent of eclamptic seizures fall out before delivery; approximately 16 percent befall more than 48 hours after delivery. (1) Death associated with preeclampsia-eclampsia may be suitable to cerebrovascular events, renal or hepatic failure, HELLP syndrome or other complications of hypertension. (3)