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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