Preeclampsia and eclampsia

Preeclampsia and eclampsia
Updated:05/10/2019
© Jun Wang, MD, PhD

General feature
  • Widespread vascular endothelial malfunction and vasospasm
  • After 20 weeks' gestation
  • Can present as late as 4-6 weeks post partum
  • Preeclampsia
Hypertension
Proteinuria
With or without pathologic edema
  • Eclampsia
New onset of grand mal seizure activity
Unexplained coma during pregnancy or postpartum
Background signs or symptoms of preeclampsia
  • HELLP
Hemolysis
Elevated Liver enzymes
Low Platelets
May have normal blood pressure
  • Symptoms usually improve after delivery
Risk factors
  • Nulliparity
  • Family history of preeclampsia, previous preeclampsia and eclampsia
  • Poor outcome of previous pregnancy: intrauterine growth retardation, abruptio placentae, or fetal death
  • Multifetal gestations, hydatid mole, fetal hydrops, primigravida
  • Pregnancy in teen or those > 35, lower socioeconomic status, primigravida
  • Others: diabetes, renal disease, etc.
Pathogenesis
  • Failure in replacement of endothelial cells with cytotrophoblasts
  • Placental ischemia causing increased thromboplastin production
  • Subsequent vasoconstriction and associated hypertension, proteinuria, edema
  • Central nervous system disorder (eclampsia) if untreated
Pathological findings
  • Smaller than normal placenta
  • Villous ischemia
  • Fibrinoid necrosis of uterine vessels
  • Atheromatous plaque, thrombosis, hypovascular villi, etc
Treatment
  • Primary objective: safety of the mother and then delivery of a healthy newborn
  • Delivery, If ≥37 weeks of gestation, or with features of severe disease
  • Expectant management including close monitoring If < 37 weeks without severe disease
  • If seizure is witnessed
Maintaining airway patency and preventing
Prevention of maternal hypoxia and trauma
Treatment of severe hypertension, if present
Prevention of recurrent seizures
Evaluation for prompt delivery



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