Preeclampsia

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Preeclampsia is the development of hypertension with albuminuria or edema between the 20th week of pregnancy and the end of the first week postpartum. Eclampsia is the set of convulsive seizures or coma without other etiology occurring in the same time period.

Gestational hypertension is a mild isolated increase in blood pressure (>140/90), usually near term. Approximately 15% of these women will progress to preeclampsia, and so should be monitored closely. 5-7% of pregnancies ultimately end in preeclampsia, which presents with a classic triad of hypertension, proteinuria, and edema. Preeclampsia is a multi-system disease rather than a pregnancy variant of essential hypertension.

Preeclampsia usually shows with endothelial cell injury, generalized vasospasm, and activation of the coagulation system.

Management

In a case of mild preeclampsia (bp >140/90; proteinuria), one must first establish whether underlying cause exists, and rule out end organ involvement. Next, the physician should establish the well-being of the fetus. Management then involves heightened maternal and fetal surveillance, with regular delivery at term.

In a case of severe preeclampsia (bp >160/110; proteinuria; end-organ damage; etc), delivery must happen regardless of gestational age. Throughout, the well-being of the mother and fetus should be monitored. The woman should also be given antihypertensives to prevent a cerebrovascular aneurism, and seizure prophylaxis.

In both mild and severe cases, the preeclampsia process abates after delivery.

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