PREECLAMPSIA

A hypertensive disorder related to pregnancy, known as new-onset hypertension, is called

preeclampsia. Initial presentation is most common in near-term pregnancies, or after 20 weeks of
gestation in particular. The usual indicators of preeclampsia are high blood pressure, reaching up
to 140 mmHg of systolic blood pressure and 90 mmHg of diastolic blood pressure on two
occasions at least 4 hours apart, edema and proteinuria (elevated protein in the urine). Some of
the risk factors include preeclampsia from previous pregnancies, diabetes, and obesity. The
causes of its occurrence are placental dysfunction, damage to blood vessels, an autoimmune
condition, and renal impairment. For confirmation, a pregnant woman has to undergo the
necessary diagnostic exams. Immediate care is advised once preeclampsia is confirmed to
prevent more serious complications.
Take note:
Gestational hypertension is when a woman with no history of hypertension develops high blood
pressure after 20 weeks of gestation. No features of proteinuria, edema.
Preeclampsia is when a pregnant women experience sudden high blood pressure after 20 weeks
with warning signs of hypertension, proteinuria and edema.
Chronic hypertension with superimposed preeclampsia is Chronic hypertension + signs of
preeclampsia
(3) Warning signs/ Significant features:
 Hypertension (140/90 mmHg)
 Edema
 Proteinuria (elevated protein in the urine)
Other symptoms:
 Headache
 Blurred vision
 Right Upper Quadrant Abdominal Pain
 Nausea or vomiting
 Decreased urine output
 Shortness of breath
Risk factors:
 More common in first pregnancies
 Chronic hypertension
 Obesity (weight >25 pounds)
 Diabetes/Kidney disease/Lupus
 Multiple pregnancies
 Family history
  Race: Black American
Complications if left unattended:
 Maternal organ damage/failure
 Impaired fetal growth
 Placental abruption (separation of placenta from uterus)
 Preterm birth
 Pregnancy loss/ stillbirth
Criteria for the diagnosis of preeclampsia
 Systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg on two
occasions at least four hours apart after 20 weeks of gestation in a previously
normotensive patient and
 Proteinuria ≥0.3 grams in a 24-hour urine specimen or protein (mg/dL)/creatinine
(mg/dL) ratio ≥0.3
Dipstick 1+ if a quantitative measurement is unavailable
In patients with new-onset hypertension without proteinuria, the new onset of any of the
following is diagnostic of preeclampsia:
 Platelet count <100,000/microliter
 Serum creatinine >1.1 mg/dL or doubling of serum creatinine in the absence of other
renal disease
 Liver transaminases at least twice the normal concentrations
 Pulmonary edema
 Cerebral or visual symptoms
Anatomy and Physiology
 The placenta is a temporary organ that connects your baby to your uterus during
pregnancy. The placenta develops shortly after conception and attaches to the wall of your
uterus. Your baby is connected to the placenta by the umbilical cord. Together, the placenta and
umbilical cord act as your baby's lifeline while in the uterus. Functions of the placenta include:
● Provides your baby with oxygen and nutrients.
● Removes harmful waste and carbon dioxide from your baby.
● Produces hormones that help your baby grow.
● Passes immunity from you to your baby.
● Helps protect your baby.
 The umbilical cord is a helical and tubular blood conduit connecting the fetus to the
placenta. The umbilical cord achieves its final form by the 12th week of gestation and normally
contains two arteries and a single vein, all embedded in Wharton's jelly.
Etiology and Symptomatology
The exact cause of preeclampsia likely involves several factors. Experts believe it begins
in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in a pregnancy,
new blood vessels develop and evolve to supply oxygen and nutrients to the placenta.
In women with preeclampsia, these blood vessels don't seem to develop or work properly.
Problems with how well blood circulates in the placenta may lead to the irregular regulation of
blood pressure in the mother.
Etiology
Predisposing Factors Rationale
Age (35 years and Advanced maternal age is associated with a decrease in egg quality. This
above) means that as your age goes up, your egg quality goes down. "Older" eggs
are more likely to cause chromosomal anomalies. Another reason there are
more complications after 35 is that your chances of developing most chronic
medical conditions increase as you age. Your body simply responds to these
conditions differently once you are older. These chronic medical conditions
can affect pregnancy and delivery.
Race Black American women are consistently at higher risk of preeclampsia
incidence, morbidity, and mortality than their white counterparts. The study
noted a higher prevalence of preeclampisa risk factors among U.S.-born
Black women: smoking, diabetes, obesity, stress and previous pregnancies.
Precipitating Factors Rationale
First pregnancy It was hypothesized in one of the research studies that pre-eclampsia is more
common in first pregnancies because women who experience pre-eclampsia
during their first pregnancy, whom might have an increased risk for genetic
or environmental reasons, might decide not to take further risks and have no
more pregnancies.
Chronic hypertension Chronic hypertension means having high blood pressure before you get
pregnant or before 20 weeks of pregnancy.1 Women who have chronic
hypertension can also get preeclampsia in the second or third trimester of
pregnancy
Obesity (weight It promotes insulin resistance that results of pre-pregnancy obesity or by an
greater than 25 excessive weight gain during gestation is associated with a reduced
pounds) cytotrophoblast migration and uterine spiral artery remodeling, which in turn
conduce to placental hypoxia and ischemia.
Diabetes Mellitus These two conditions are closely related to each other. Gestational diabetes
increases the risk of preeclampsia since high glucose levels can cause high
blood pressure.
Kidney disease/Lupus Chronic kidney disease may predispose to the development of preeclampsia
due to comorbid conditions, such as hypertension. Because your kidneys are
not getting enough blood, they react by making a hormone that makes your
blood pressure rise. The risk of preeclampsia is higher in women with lupus
who have a history of kidney disease.
Multiple pregnancies In women with twin pregnancies, a high-normal systolic or diastolic BP
(above 120 systolic or 80 diastolic prior to 30 weeks, or above 130 systolic
or 84 diastolic after 30 weeks) is associated with a significantly increased
risk of gestational hypertension and preeclampsia.
Family history Preeclampsia is also more common among women who have histories of
certain health conditions such as diabetes and lupus.

Symptomatology
Symptoms Rationale
Hypertension (140/90 In women with preeclampsia, these blood vessels don't seem to develop or
mmHg) work properly. Problems with how well blood circulates in the placenta may
lead to the irregular regulation of blood pressure in the mother.
Edema Generalized edema in preeclampsia may be due to capillary leak from
endothelial damage and/or increased sodium retention that may be related to
glomerular endotheliosis and proteinuria.
Proteinuria When your kidneys are not working as well as they should, protein can leak
through your kidney's filters and into your urine (i.e., your pee). Protein in
your urine is called proteinuria or albuminuria. It is a sign that your kidneys
are damaged.
Headache As pre-eclampsia progresses, it may cause: severe headaches.
 Blurred vision Vision changes are one of the most serious symptoms of preeclampsia. They
may be associated with central nervous system irritation or be an indication
of swelling of the brain (cerebral edema).
(RUQ)Abdominal Preeclampsia can create abnormalities in the liver, such as liver hypertrophy,
pain or enlargement of the liver, which is what causes the epigastric pain.

Nausea/Vomiting For most women, morning sickness will go away after the first trimester. If
nausea and vomiting come back after mid-pregnancy, it can be a sign you're
developing preeclampsia.
Decreased urine The kidney is the organ most likely to be affected by endothelial injury in
output preeclampsia. Kidney injury is rare but can be seen in severe disease.
Oliguria (urine output < 500 cc/day) indicates a much more severe clinical
picture. Sudden onset or worsening of edema is a cause of concern in
preeclamptic patients.
Shortness of breath Shortness of breath, caused by fluid in the lungs.

General Pathophysiology