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PREECLAMPSIA / PREGNANCY INDUCED HYPERTENSION

PREECLAMPSIA / PREGNANCY INDUCED HYPERTENSION. Incidence. Preeclampsia complicates at least 10% of first pregnancies. Etiology. The etiology of preeclampsia is unknown but may be related to abnormal placentation. Pathophysiology.

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PREECLAMPSIA / PREGNANCY INDUCED HYPERTENSION

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  1. PREECLAMPSIA / PREGNANCY INDUCED HYPERTENSION

  2. Incidence • Preeclampsia complicates at least 10% of first pregnancies

  3. Etiology • The etiology of preeclampsia is unknown but may be related to abnormal placentation.

  4. Pathophysiology • Preeclampsia most commonly presents in the second half of pregnancy. • It is a multisystem disease associated with diffuse vasospasm and endothelial damage.

  5. Pathophysiology • Pathology demonstrates areas of endothelial swelling, edema, micro-infarctions and micro-hemorrhages in effected organs. • The main target organs are the brain, kidney, liver, lungs, and heart.

  6. Risk Factors • first pregnancy • new matings • younger than 18 and older than 35 • prior history • family history • multiple gestations • hydatidiform mole • hydrops • triploidy

  7. Risk Factors • chronic hypertension • diabetes • renal disease • SLE • thrombophilias (especially APLA) • obesity

  8. Diagnosis • Though important manifestations of the disease, hypertension, proteinuria, and edema are not essential to the diagnosis of preeclampsia. • The likelihood of preeclampsia increases when more elements of the disease are present.

  9. Symptoms • headache • visual disturbances • epigastric or RUQ discomfort • edema/ rapid weight gain

  10. Signs • hypertension • retinal vasospasm • hepatic tenderness • facial and hand edema • clonus

  11. Laboratory Manifestations • proteinuria • elevated creatinine • elevated uric acid • elevated liver enzymes • elevated hemoglobin • thrombocytopenia • elevated PT and PTT • microangiopathic hemolytic anemia

  12. Life Threatening Manifestations • seizures • cerebral hemorrhage • renal failure • hepatic failure • liver hematoma with hepatic rupture • DIC • pulmonary edema • ventricular dysfunction • placental abruption

  13. Fetal Effects • Preeclampsia has significant adverse fetal effects including decreased amniotic fluid levels, decreased fetal growth, placental abruption, and intrauterine fetal demise.

  14. Treatment • When pre-eclampsia is diagnosed, it is always in the mother’s interest to deliver her baby; therefore, any delay in delivery must be because of uncertainty about the diagnosis or immaturity of the fetus.

  15. Treatment • The use of an anticonvulsant to prevent seizures should be considered. Magnesium sulfate is most commonly used. • Keep blood pressure below 180 systolic and 110 diastolic. • Minimize fluids. • Monitor patient and labs closely as status can deteriorate rapidly.

  16. Treatment • The patient with Preeclampsia can worsen or even initially present postpartum.

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