Lecture Notes on Preeclampsia and Eclampsia

Introduction

• Preeclampsia is a disorder specific to pregnancy occurring after 20 weeks of gestation and can develop up to 6 weeks postpartum.
• Characterized by new-onset hypertension and proteinuria, indicating kidney damage.
• Can affect other organs including the brain and liver.
• May present with a range of symptoms from mild to life-threatening.
• Eclampsia refers to preeclampsia cases where seizures develop.

Risk Factors

• More common in:
  • First pregnancies.
  • Multiple gestations.
  • Mothers aged 35 or older.
• Additional risk factors include:
  • Hypertension.
  • Diabetes.
  • Obesity.
  • Family history of preeclampsia.

Pathophysiology

• Abnormal placenta development is a key feature.
• Normal pregnancy: spiral arteries dilate significantly.
• Preeclampsia: arteries become fibrous, narrow, reducing blood flow to the placenta.
• Poorly perfused placenta can lead to fetal growth restriction or death.
• Hypoperfused placenta releases pro-inflammatory proteins causing endothelial dysfunction.

Endothelial Dysfunction Effects

• Vasoconstriction causes hypertension.
• Kidney effects lead to salt retention.

Diagnosis

• Hypertension defined as systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg.
• Severe cases: systolic BP ≥ 160 mm Hg, diastolic BP ≥ 110 mm Hg.
• Risks include hemorrhagic stroke, placental abruption.

Symptoms and Organ Involvement

• Kidneys: Glomerular damage causes oliguria and proteinuria.
• Eyes: Reduced retinal blood flow causes blurred vision and scotomas.
• Liver: Reduced blood flow causes liver injury, enzyme elevation, and right upper quadrant pain.
• Blood: Formation of tiny thrombi leads to hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome).
• Edema: Generalized edema, pulmonary edema (cough, shortness of breath), cerebral edema (headache, confusion, seizures).

Eclampsia

• Defined by the development of seizures in a patient with preeclampsia.

Treatment

• Delivery is the ultimate treatment as it resolves placental dysfunction.
• Decision to induce delivery depends on gestational age and severity of disease.
• Post-delivery onset managed by symptom relief and mitigating end-organ damage.
• Supportive care includes supplemental oxygen and medications for seizures, stroke, or placental abruption.

Conclusion

• Preeclampsia and eclampsia stem from a dysfunctional placenta.
• Management focuses on delivery and symptomatic relief.