Preeclampsia Disease

DESCRIPTION

Hypertension associated with proteinuria, edema, and acute excessive weight gain developing during pregnancy after 20 weeks gestation

System(s) affected: Reproductive, Cardiovascular, Nervous
Genetics: N/A
Incidence/Prevalence in USA: 5-10% of all pregnancies
Predominant age:
- Young, primigravida women
- Women over 35 years of age
Predominant sex: Female only

SIGNS AND SYMPTOMS

Elevated BP (> 140/90 [18.6/12 kPa] or increased 30 [4 kPa] systolic or increased 15 [2 kPa] diastolic) recorded on 2 BP readings 6 hours apart
Proteinuria (> 300 mg/24 hours or > 1 gram/L)
Edema
Rapid excessive weight gain (> 5 lb/week) (2.3 kg/week)
Epigastric pain
Headache
Hyperreflexia
Visual disturbances
Apprehension
Retinal arteriolar spasm
Papilledema
Retinal cotton-wool exudate
Amnesia
Oliguria
Anuria

CAUSES

Altered cardiovascular reactivity
Increased capillary permeability
Widespread endothelial dysfunction
Microthrombi
Hypertension

RISK FACTORS

Familial incidence
Lower socioeconomic
Multiple fetuses
Teenage
Collagen disorders
Females > 35 years old
Primigravida
First subsequent pregnancy with a different father
Diabetes mellitus of pregnancy
Chronic hypertension
Hydatid mole
Fetal hydrops
History of renal disease

LABORATORY

Proteinuria (> 300 mg/24 hrs or > 1 gram/L)
Uric acid increased (mild increase > 5.5 mg/dL [0.32 mmol/L]); (severe increase > 9.5 mg/dL [0.56 mmol/L])
Thrombocytopenia
CrCl < 90 mL/min/1.73m2 (0.87 mL/s/m2)
Increased BUN (> 16 mg/dL [5.7 mmol/L])
Increased creatinine (> 1.0 mg/dL [88 µmol/L])
Abnormal increased liver function tests
Increased fibrin degradation products
Increased PT
Decreased fibrinogen
Granular casts in urine
Red blood cell casts in urine
Renal tubular cell casts in urine
White blood cell casts in urine
Increased urine specific gravity
Increased T4
Thrombocytopenia
Decreased fibrinogen
Disseminated intravascular coagulation
Hyperbilirubinemia

Drugs that may alter lab results: N/A
Disorders that may alter lab results: Chronic renal disease

PATHOLOGICAL FINDINGS

Fibrin deposits in kidneys
Fibrin deposits in liver with necrosis and periportal hemorrhages
Placental vascular abnormalities

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

24 hour urine for protein

APPROPRIATE HEALTH CARE

Outpatient care if mild
Inpatient care if deterioration
Delivery of fetus as soon as possible if severe
Admit to hospital if blood pressure > 160/110 (21.3/14.6 kPa), proteinuria > 5 gm/24 hr, oliguria, cerebral or visual disturbances (scotoma, blurred vision), severe headache, altered consciousness, pulmonary edema, thrombocytopenia, impaired liver function tests, epigastric pain

GENERAL MEASURES

If outpatient, keep a daily weight record; use a home test to check for proteinuria
If outpatient, twice a week blood pressure tests

SURGICAL MEASURES

N/A

ACTIVITY

Bedrest on left side
Ambulatory only to void

DIET

Salt restriction is not good because the patient is in an intravascular contracted state
Protein 80-100 gm/day

PATIENT EDUCATION

Avoid excessive weight gain during pregnancy (> 25-30 lb [11.4-13.6 kg])

PREVENTION/AVOIDANCE

Weight control
Large scale studies do not support low dose aspirin for prevention

POSSIBLE COMPLICATIONS

Eclampsia (seizures)
Hypertensive crisis
Acute pyelonephritis
Acute fatty liver
Acute pulmonary edema

EXPECTED COURSE AND PROGNOSIS

Prevention of seizures
Delivery of viable fetus

ASSOCIATED CONDITIONS

Abruptio placenta

AGE-RELATED FACTORS

Pediatric: Increased incidence in teenagers
Geriatric: N/A
Others: Older pregnant females (> 35 years old) have increased incidence

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

MgSO4 = magnesium sulfate
CrCl = creatinine clearance

Clinical Investigations

ROLE OF HOMOEOPATHY

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