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APGO educational topic number 18
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preeclampsia preeclampsia is a
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hypertensive disorder of pregnancy
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diagnosed after 20 weeks gestation it
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clamps he has new onset seizures in a
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woman with preeclampsia hypertensive
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disorders of pregnancy complicate up to
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10 percent of pregnancies worldwide and
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the incidence of preeclampsia in the
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United States has increased by 25
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percent in the last two decades
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preeclampsia is a leading cause of
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maternal and perinatal morbidity and
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mortality with an estimated 50,000 to
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60,000 related deaths per year worldwide
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the objectives of this video are to
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define the types of hypertension in
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pregnancy describe the pathophysiology
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of preeclampsia list the risk factors
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for preeclampsia and describe the
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diagnosis management and complications
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of preeclampsia the four types of
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hypertension and pregnancy are
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preeclampsia chronic hypertension
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chronic hypertension with superimposed
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preeclampsia and gestational
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hypertension preeclampsia is defined as
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new onset hypertension after 20 weeks
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gestation with proteinuria or and organ
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dysfunction chronic hypertension
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predates the pregnancy or is diagnosed
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prior to 20 weeks gestation superimposed
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preeclampsia involved signs and symptoms
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of the disorder along with chronic
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hypertension gestational hypertension is
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an elevated blood pressure diagnosed
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after 20 weeks without the systemic
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findings of preeclampsia during normal
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pregnancy fetal e derived saito
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trophoblasts invade the maternal uterine
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spiral arteries and replace their
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endothelium converting the high
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resistance small diameter vessels into
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high capacitance low resistance vessels
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to ensure adequate delivery of maternal
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blood to the placenta as you can see in
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this healthy placenta the spiral artery
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is lined with saito trophoblasts making
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it nice and wide to ensure a lot of
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blood flow in a woman destined to
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develop preeclampsia later in her
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pregnancy this process does not occur
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correctly and the UH thérèse remain
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narrow decreasing blood flow to the
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placenta and causing hypoxemia
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studies have shown abnormalities in
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vascular genic and angiogenic signaling
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pathways but the exact mechanism for
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this abnormal trophoblast invasion
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remains unclear the biggest risk factor
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for preeclampsia is history of
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preeclampsia in a previous pregnancy
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which increases the risk Sevenfold
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preeclampsia on a first-degree relative
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Prime at parity and multiple gestation
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are also important risk factors to
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consider the mother’s past medical
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history should also be reviewed for risk
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factors including pre-existing
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hypertension renal disease
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hypercoagulability diabetes obesity
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lupus and age greater than 40 years
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nonetheless
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it is important to note that most cases
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of preeclampsia occur in healthy and
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nulliparous women with no other obvious
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risks the diagnosis of preeclampsia can
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only be made with a combination of
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elevated blood pressure and proteinuria
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or systemic findings the blood pressure
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must be greater than 140 over 90 on two
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occasions at least four hours apart
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after 20 weeks gestation proteinuria is
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defined as greater than 300 milligrams
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per 24-hour urine collection a protein
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creatinine ratio greater than 0.3 or a
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dipstick reading of 1 plus in the
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absence of protein Oriya severe features
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including a platelet count less than a
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hundred thousand serum creatinine
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greater than 1.1 elevated liver
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transaminases 2 twice normal
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concentration pulmonary edema or new
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onset cerebral or visual symptoms can
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also make the diagnosis the management
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of patients with preeclampsia involves
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weighing the risks of maturity of the
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fetus with the risks of maternal
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morbidity of worsening disease
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progression preeclampsia is managed by
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close surveillance until 37 weeks
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estimated gestational age this involves
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monitoring the mother carefully with
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frequent blood pressure monitoring serum
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and urine evaluation to watch for
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disease progression antihypertensives
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such as hydralazine labetalol or
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nifedipine should only be started if the
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blood pressure exceeds one 60 systolic
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or 110 diastolic ultrasound for fetal
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growth should be
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offered and if evidence of restriction
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is found fetal placental assessment
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including umbilical artery Doppler
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velocimetry is recommended the fetus
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should be monitored with twice weekly
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non stress tests as well betamethasone
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should be administered for fetal lung
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maturity prior to 34 weeks estimated
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gestational age and delivery should be
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initiated at 37 weeks once the diagnosis
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of preeclampsia with severe features is
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made delivery should be initiated after
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34 weeks if there is concern for rapid
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disease progression then delivery will
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need to be initiated even prior to 34
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weeks
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magnesium sulfate is administered for
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seizure prophylaxis the mode of delivery
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should be decided by fetal presentation
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cervical status fetal gestational age
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and maternal fetal condition eclamptic
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seizure czar scary occurrences and it is
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critically important to stabilize the
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mom first for this will stabilise the
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fetus women with the clamp Dixie’s
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should be treated with parenteral
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magnesium mode of delivery is again
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decided by maternal fetal condition and
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vaginal delivery can often be attempted
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with labor induction even in the case of
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eclamptic seizure x’ preeclampsia is a
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progressive disease the hypertension may
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worsen or signs of end organ dysfunction
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may manifest over time including
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eclampsia help syndrome placental
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abruption stroke liver or kidney injury
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and a RDS ecliptics seizures may occur
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before during or after labor and result
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in high perinatal and maternal morbidity
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and mortality help stands for hemolysis
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elevated liver enzymes and low platelets
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is usually diagnosed in the third
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trimester of a woman with preeclampsia
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or gestational hypertension with
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symptoms of epigastric pain malaise
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nausea and/or headaches and can progress
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to di c all of these issues are solved
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by delivery of the baby and placenta
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fetal complications include fetal growth
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restriction and the issues associated
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with increased risk of preterm delivery
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and
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Sentell abruption this concludes the
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aapko video on preeclampsia we have
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reviewed the definition clinical
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features and management techniques of
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this common condition in pregnant women