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Pre-eclampsia

Updated : January 25, 2024





Background

Preeclampsia is a pregnancy complication that affects around 5-8% of pregnant women worldwide. It is a serious medical condition that can lead to maternal and fetal morbidity and mortality. Preeclampsia is characterized by high blood pressure and damage to organs such as the liver and kidneys, which can result in a range of complications such as seizures, stroke, and fetal growth restriction.

The exact cause of preeclampsia is unknown, but it is believed to be related to problems with the placenta, which supplies oxygen and nutrients to the developing fetus. Risk factors for preeclampsia include a first-time pregnancy, a history of preeclampsia, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions. Early detection and management of preeclampsia are important to prevent complications and improve outcomes for both mother and baby.

Epidemiology

Preeclampsia is a common pregnancy complication that affects approximately 5-8% of pregnant women worldwide. The incidence of preeclampsia varies by country, with higher rates reported in developing countries. The incidence of preeclampsia also increases with maternal age, and women who are pregnant for the first time are at higher risk than women who have had previous pregnancies.

Preeclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. It is responsible for approximately 14% of maternal deaths globally, and up to 25% of preterm births are due to preeclampsia. Preeclampsia can also cause long-term health problems for women, such as an increased risk of cardiovascular disease later in life.

Early detection and management of preeclampsia are important to prevent complications and improve outcomes for both mother and baby. Prenatal care, including regular blood pressure monitoring and urine testing, can help identify women at risk for developing preeclampsia. Women with preeclampsia may require close monitoring, medication to control blood pressure, and early delivery of the baby in severe cases.

Anatomy

Pathophysiology

The exact cause of preeclampsia is not fully understood, but it is thought to be related to problems with the development and function of the placenta. Normally, the placenta supplies oxygen and nutrients to the developing fetus, but in preeclampsia, the blood vessels in the placenta become narrow and do not function properly. This leads to reduced blood flow to the fetus and inadequate oxygen and nutrient delivery.

As a result of the impaired placental function, the mother’s body responds by releasing factors that cause damage to the blood vessels and organs such as the liver and kidneys. This results in increased blood pressure, protein in the urine, and other symptoms associated with preeclampsia. Preeclampsia can also cause changes in blood clotting, which can increase the risk of complications such as stroke and can lead to problems with the baby’s growth and development.

In severe cases, preeclampsia can progress to eclampsia, which is characterized by seizures and can be life-threatening for both mother and baby. Risk factors for preeclampsia include a first-time pregnancy, a history of preeclampsia, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions such as hypertension, diabetes, kidney disease, and autoimmune disorders.

Early detection and management of preeclampsia are important to prevent complications and improve outcomes for both mother and baby. Prenatal care, including regular blood pressure monitoring and urine testing, can help identify women at risk for developing preeclampsia. Women with preeclampsia may require close monitoring, medication to control blood pressure, and early delivery of the baby in severe cases.

Etiology

The exact cause of preeclampsia is not fully understood, but it is believed to be related to problems with the development and function of the placenta. Factors that may contribute to the development of preeclampsia include:

  • Insufficient blood flow to the placenta: This can occur due to various reasons, such as abnormal development of blood vessels in the placenta, blood clotting disorders, autoimmune disorders, or genetic factors.
  • Endothelial dysfunction: The endothelium is the inner lining of blood vessels, and in preeclampsia, it becomes damaged and does not function properly. This leads to a range of problems, such as increased blood pressure, protein in the urine, and other complications associated with preeclampsia.
  • Immune system dysfunction: Preeclampsia may be related to abnormal immune responses, which can lead to inflammation and damage to blood vessels in the placenta.
  • Genetic factors: Preeclampsia may be influenced by genetic factors, as it tends to run in families. Specific genes may increase the risk of developing preeclampsia or contribute to the development of the condition.
  • Other factors: Other factors that may increase the risk of developing preeclampsia include a first-time pregnancy, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions such as hypertension, diabetes, kidney disease, and autoimmune disorders.

While the exact cause of preeclampsia is not known, early detection and management of the condition can help prevent complications and improve outcomes for both mother and baby. Pregnant women should receive regular prenatal care, including blood pressure monitoring and urine testing, to identify any signs of preeclampsia.

Genetics

Prognostic Factors

Several prognostic factors can affect the outcomes of preeclampsia, including:

  • Gestational age: The earlier preeclampsia develops in pregnancy, the higher the risk of adverse outcomes.
  • The severity of preeclampsia: Women with severe preeclampsia are at higher risk of adverse outcomes such as eclampsia, HELLP syndrome, placental abruption, and maternal and fetal death.
  • Maternal age: Women who are younger than 20 years or older than 40 years are at a higher risk of developing preeclampsia.
  • Multiparity: Women who have had multiple pregnancies are at higher risk of developing preeclampsia.
  • Obesity: Women who are obese (body mass index of 30 or higher) are at higher risk of developing preeclampsia.
  • Chronic hypertension: Women who have pre-existing hypertension are at higher risk of developing preeclampsia.
  • Diabetes: Women with pre-existing diabetes are at higher risk of developing preeclampsia.
  • Autoimmune disorders: Women with autoimmune disorders such as lupus or antiphospholipid syndrome are at higher risk of developing preeclampsia.
  • Fetal growth restriction: Women with preeclampsia are at higher risk of developing fetal growth restriction, which can further complicate the pregnancy.

The prognosis of preeclampsia depends on several factors, including the severity of the condition, the gestational age of the fetus, and the presence of complications. Close monitoring and prompt treatment are essential to improve outcomes for both mother and baby.

Clinical History

Clinical history

The clinical history of preeclampsia typically includes the following:

  • Gestational age: Preeclampsia typically occurs after 20 weeks of gestation, although it can occur earlier in some cases.
  • Blood pressure: Preeclampsia is characterized by high blood pressure, which is defined as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher, measured on at least two occasions, at least 4 hours apart, on a woman with previously normal blood pressure.
  • Proteinuria: Preeclampsia is also characterized by the presence of proteinuria, which is defined as a urinary protein-to-creatinine ratio of 0.3 or higher or a 24-hour urine protein excretion of 300 mg or higher.
  • Symptoms: Women with preeclampsia may also experience symptoms such as headache, visual disturbances, abdominal pain, nausea, and vomiting.
  • Risk factors: Women with risk factors for preeclampsia, such as a history of preeclampsia in a previous pregnancy, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions such as hypertension, diabetes, kidney disease, and autoimmune disorders, should be closely monitored during pregnancy.
  • Fetal assessment: Preeclampsia can also affect fetal growth and development, so fetal assessment may be performed, such as fetal ultrasound or nonstress test.

Physical Examination

Physical examination

The physical examination of a woman with suspected preeclampsia may include the following:

  • Blood pressure measurement: The woman’s blood pressure should be measured using a properly calibrated blood pressure cuff and a stethoscope or an automated blood pressure machine. Blood pressure should be measured in both arms to detect any differences.
  • Urine dipstick test: A urine dipstick test can be used to detect the presence of protein in the urine, which is a hallmark of preeclampsia.
  • General examination: The woman’s general appearance should be assessed, including her level of consciousness, mental status, and presence of any signs of distress.
  • Visual examination: The woman’s eyes should be examined for signs of visual disturbance, such as blurry vision, seeing spots or flashing lights, or complete loss of vision.
  • Abdominal examination: The woman’s abdomen should be examined to assess the size and growth of the fetus and to detect any tenderness or pain.
  • Fetal monitoring: Fetal monitoring may be performed to assess fetal well-being, such as fetal heart rate monitoring or fetal ultrasound.
  • Other signs: Other signs of preeclampsia, such as edema (swelling), especially in the face and hands, headache, and abdominal pain, should be evaluated.

It is important to perform a thorough physical examination of a woman with suspected preeclampsia to assess the severity of the condition and to determine the appropriate management strategy. Prompt diagnosis and management of preeclampsia can help prevent complications and improve outcomes for both mother and baby.

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Differential diagnosis

The diagnosis of preeclampsia is based on a combination of signs and symptoms, including high blood pressure and protein in the urine, that occur after 20 weeks of gestation. However, other conditions can cause similar symptoms, and it is important to consider these in the differential diagnosis of preeclampsia. Some of the conditions that may be considered in the differential diagnosis of preeclampsia include:

  • Gestational hypertension: This is a condition in which a woman develops high blood pressure after 20 weeks of pregnancy, but there is no proteinuria or other signs of preeclampsia.
  • Chronic hypertension: Some women have high blood pressure before pregnancy or develop it during the first 20 weeks of pregnancy, which is not related to preeclampsia.
  • HELLP syndrome: This is a severe form of preeclampsia that involves hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelet count.
  • Acute fatty liver of pregnancy: This is a rare condition that occurs in the third trimester of pregnancy, is characterized by liver dysfunction, and may cause symptoms similar to preeclampsia.
  • Renal disease: Certain kidney disorders can cause proteinuria and high blood pressure, which can be mistaken for preeclampsia.
  • Other medical conditions: Medical conditions such as lupus, diabetes, and thrombophilia may cause symptoms similar to preeclampsia.

It is important to differentiate between these conditions and preeclampsia, as they may require different management strategies. Early detection, proper evaluation, and management of these conditions can improve maternal and fetal outcomes.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

The treatment of preeclampsia depends on the severity of the condition and the gestational age of the fetus. The primary goal of treatment is to prevent complications and ensure the safety of both mother and baby. Treatment options may include the following:

  • Delivery: The only cure for preeclampsia is delivery of the baby and placenta. If the woman is close to term (37 weeks or later), the delivery may be recommended. If the woman is not close to term, the decision to deliver depends on the severity of the preeclampsia and the status of the fetus.
  • Blood pressure control: If the woman’s blood pressure is elevated, medications such as antihypertensive drugs may be used to lower blood pressure to a safe range.
  • Magnesium sulfate: Magnesium sulfate may be used to prevent seizures (eclampsia) in women with severe preeclampsia.
  • Corticosteroids: Corticosteroids may be given to women with preeclampsia to help the baby’s lungs mature in cases where preterm delivery is anticipated.
  • Close monitoring: Women with preeclampsia require close monitoring of blood pressure, urine output, fetal well-being, and maternal symptoms.
  • Hospitalization: Women with severe preeclampsia may require hospitalization for close monitoring and treatment.
  • Management of complications: Complications such as HELLP syndrome, placental abruption, and acute renal failure may require additional management strategies.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK570611/

Pre-eclampsia

Updated : January 25, 2024




Preeclampsia is a pregnancy complication that affects around 5-8% of pregnant women worldwide. It is a serious medical condition that can lead to maternal and fetal morbidity and mortality. Preeclampsia is characterized by high blood pressure and damage to organs such as the liver and kidneys, which can result in a range of complications such as seizures, stroke, and fetal growth restriction.

The exact cause of preeclampsia is unknown, but it is believed to be related to problems with the placenta, which supplies oxygen and nutrients to the developing fetus. Risk factors for preeclampsia include a first-time pregnancy, a history of preeclampsia, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions. Early detection and management of preeclampsia are important to prevent complications and improve outcomes for both mother and baby.

Preeclampsia is a common pregnancy complication that affects approximately 5-8% of pregnant women worldwide. The incidence of preeclampsia varies by country, with higher rates reported in developing countries. The incidence of preeclampsia also increases with maternal age, and women who are pregnant for the first time are at higher risk than women who have had previous pregnancies.

Preeclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. It is responsible for approximately 14% of maternal deaths globally, and up to 25% of preterm births are due to preeclampsia. Preeclampsia can also cause long-term health problems for women, such as an increased risk of cardiovascular disease later in life.

Early detection and management of preeclampsia are important to prevent complications and improve outcomes for both mother and baby. Prenatal care, including regular blood pressure monitoring and urine testing, can help identify women at risk for developing preeclampsia. Women with preeclampsia may require close monitoring, medication to control blood pressure, and early delivery of the baby in severe cases.

The exact cause of preeclampsia is not fully understood, but it is thought to be related to problems with the development and function of the placenta. Normally, the placenta supplies oxygen and nutrients to the developing fetus, but in preeclampsia, the blood vessels in the placenta become narrow and do not function properly. This leads to reduced blood flow to the fetus and inadequate oxygen and nutrient delivery.

As a result of the impaired placental function, the mother’s body responds by releasing factors that cause damage to the blood vessels and organs such as the liver and kidneys. This results in increased blood pressure, protein in the urine, and other symptoms associated with preeclampsia. Preeclampsia can also cause changes in blood clotting, which can increase the risk of complications such as stroke and can lead to problems with the baby’s growth and development.

In severe cases, preeclampsia can progress to eclampsia, which is characterized by seizures and can be life-threatening for both mother and baby. Risk factors for preeclampsia include a first-time pregnancy, a history of preeclampsia, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions such as hypertension, diabetes, kidney disease, and autoimmune disorders.

Early detection and management of preeclampsia are important to prevent complications and improve outcomes for both mother and baby. Prenatal care, including regular blood pressure monitoring and urine testing, can help identify women at risk for developing preeclampsia. Women with preeclampsia may require close monitoring, medication to control blood pressure, and early delivery of the baby in severe cases.

The exact cause of preeclampsia is not fully understood, but it is believed to be related to problems with the development and function of the placenta. Factors that may contribute to the development of preeclampsia include:

  • Insufficient blood flow to the placenta: This can occur due to various reasons, such as abnormal development of blood vessels in the placenta, blood clotting disorders, autoimmune disorders, or genetic factors.
  • Endothelial dysfunction: The endothelium is the inner lining of blood vessels, and in preeclampsia, it becomes damaged and does not function properly. This leads to a range of problems, such as increased blood pressure, protein in the urine, and other complications associated with preeclampsia.
  • Immune system dysfunction: Preeclampsia may be related to abnormal immune responses, which can lead to inflammation and damage to blood vessels in the placenta.
  • Genetic factors: Preeclampsia may be influenced by genetic factors, as it tends to run in families. Specific genes may increase the risk of developing preeclampsia or contribute to the development of the condition.
  • Other factors: Other factors that may increase the risk of developing preeclampsia include a first-time pregnancy, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions such as hypertension, diabetes, kidney disease, and autoimmune disorders.

While the exact cause of preeclampsia is not known, early detection and management of the condition can help prevent complications and improve outcomes for both mother and baby. Pregnant women should receive regular prenatal care, including blood pressure monitoring and urine testing, to identify any signs of preeclampsia.

Several prognostic factors can affect the outcomes of preeclampsia, including:

  • Gestational age: The earlier preeclampsia develops in pregnancy, the higher the risk of adverse outcomes.
  • The severity of preeclampsia: Women with severe preeclampsia are at higher risk of adverse outcomes such as eclampsia, HELLP syndrome, placental abruption, and maternal and fetal death.
  • Maternal age: Women who are younger than 20 years or older than 40 years are at a higher risk of developing preeclampsia.
  • Multiparity: Women who have had multiple pregnancies are at higher risk of developing preeclampsia.
  • Obesity: Women who are obese (body mass index of 30 or higher) are at higher risk of developing preeclampsia.
  • Chronic hypertension: Women who have pre-existing hypertension are at higher risk of developing preeclampsia.
  • Diabetes: Women with pre-existing diabetes are at higher risk of developing preeclampsia.
  • Autoimmune disorders: Women with autoimmune disorders such as lupus or antiphospholipid syndrome are at higher risk of developing preeclampsia.
  • Fetal growth restriction: Women with preeclampsia are at higher risk of developing fetal growth restriction, which can further complicate the pregnancy.

The prognosis of preeclampsia depends on several factors, including the severity of the condition, the gestational age of the fetus, and the presence of complications. Close monitoring and prompt treatment are essential to improve outcomes for both mother and baby.

Clinical history

The clinical history of preeclampsia typically includes the following:

  • Gestational age: Preeclampsia typically occurs after 20 weeks of gestation, although it can occur earlier in some cases.
  • Blood pressure: Preeclampsia is characterized by high blood pressure, which is defined as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher, measured on at least two occasions, at least 4 hours apart, on a woman with previously normal blood pressure.
  • Proteinuria: Preeclampsia is also characterized by the presence of proteinuria, which is defined as a urinary protein-to-creatinine ratio of 0.3 or higher or a 24-hour urine protein excretion of 300 mg or higher.
  • Symptoms: Women with preeclampsia may also experience symptoms such as headache, visual disturbances, abdominal pain, nausea, and vomiting.
  • Risk factors: Women with risk factors for preeclampsia, such as a history of preeclampsia in a previous pregnancy, multiple gestations, advanced maternal age, obesity, and pre-existing medical conditions such as hypertension, diabetes, kidney disease, and autoimmune disorders, should be closely monitored during pregnancy.
  • Fetal assessment: Preeclampsia can also affect fetal growth and development, so fetal assessment may be performed, such as fetal ultrasound or nonstress test.

Physical examination

The physical examination of a woman with suspected preeclampsia may include the following:

  • Blood pressure measurement: The woman’s blood pressure should be measured using a properly calibrated blood pressure cuff and a stethoscope or an automated blood pressure machine. Blood pressure should be measured in both arms to detect any differences.
  • Urine dipstick test: A urine dipstick test can be used to detect the presence of protein in the urine, which is a hallmark of preeclampsia.
  • General examination: The woman’s general appearance should be assessed, including her level of consciousness, mental status, and presence of any signs of distress.
  • Visual examination: The woman’s eyes should be examined for signs of visual disturbance, such as blurry vision, seeing spots or flashing lights, or complete loss of vision.
  • Abdominal examination: The woman’s abdomen should be examined to assess the size and growth of the fetus and to detect any tenderness or pain.
  • Fetal monitoring: Fetal monitoring may be performed to assess fetal well-being, such as fetal heart rate monitoring or fetal ultrasound.
  • Other signs: Other signs of preeclampsia, such as edema (swelling), especially in the face and hands, headache, and abdominal pain, should be evaluated.

It is important to perform a thorough physical examination of a woman with suspected preeclampsia to assess the severity of the condition and to determine the appropriate management strategy. Prompt diagnosis and management of preeclampsia can help prevent complications and improve outcomes for both mother and baby.

Differential diagnosis

The diagnosis of preeclampsia is based on a combination of signs and symptoms, including high blood pressure and protein in the urine, that occur after 20 weeks of gestation. However, other conditions can cause similar symptoms, and it is important to consider these in the differential diagnosis of preeclampsia. Some of the conditions that may be considered in the differential diagnosis of preeclampsia include:

  • Gestational hypertension: This is a condition in which a woman develops high blood pressure after 20 weeks of pregnancy, but there is no proteinuria or other signs of preeclampsia.
  • Chronic hypertension: Some women have high blood pressure before pregnancy or develop it during the first 20 weeks of pregnancy, which is not related to preeclampsia.
  • HELLP syndrome: This is a severe form of preeclampsia that involves hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelet count.
  • Acute fatty liver of pregnancy: This is a rare condition that occurs in the third trimester of pregnancy, is characterized by liver dysfunction, and may cause symptoms similar to preeclampsia.
  • Renal disease: Certain kidney disorders can cause proteinuria and high blood pressure, which can be mistaken for preeclampsia.
  • Other medical conditions: Medical conditions such as lupus, diabetes, and thrombophilia may cause symptoms similar to preeclampsia.

It is important to differentiate between these conditions and preeclampsia, as they may require different management strategies. Early detection, proper evaluation, and management of these conditions can improve maternal and fetal outcomes.

The treatment of preeclampsia depends on the severity of the condition and the gestational age of the fetus. The primary goal of treatment is to prevent complications and ensure the safety of both mother and baby. Treatment options may include the following:

  • Delivery: The only cure for preeclampsia is delivery of the baby and placenta. If the woman is close to term (37 weeks or later), the delivery may be recommended. If the woman is not close to term, the decision to deliver depends on the severity of the preeclampsia and the status of the fetus.
  • Blood pressure control: If the woman’s blood pressure is elevated, medications such as antihypertensive drugs may be used to lower blood pressure to a safe range.
  • Magnesium sulfate: Magnesium sulfate may be used to prevent seizures (eclampsia) in women with severe preeclampsia.
  • Corticosteroids: Corticosteroids may be given to women with preeclampsia to help the baby’s lungs mature in cases where preterm delivery is anticipated.
  • Close monitoring: Women with preeclampsia require close monitoring of blood pressure, urine output, fetal well-being, and maternal symptoms.
  • Hospitalization: Women with severe preeclampsia may require hospitalization for close monitoring and treatment.
  • Management of complications: Complications such as HELLP syndrome, placental abruption, and acute renal failure may require additional management strategies.

https://www.ncbi.nlm.nih.gov/books/NBK570611/