preclampsia is a disorder that only happens in pregnant women and it happens after 20 weeks gestation and in some cases develops up to 6 weeks after delivery preclampsia causes new onset hypertension in protein UA which is a marker of kidney damage and can also cause damage to other organs like the brain in the liver there can be a wide range of symptoms for some women there might be no symptoms or only mild ones whereas for others it can turn into a life-threatening illness if a woman with preclampsia develops seizures she's then said to have eclampsia preclampsia tends to happen more often during a first pregnancy in pregnancies with multiple gestations or in mothers 35 years or older other risk factors include having hypertension diabetes obesity or a family history of preclampsia all right but why do these Chang happen in preclampsia and eclampsia well the exact cause is unclear but a key pathophysiologic feature is the development of an abnormal placenta normally during pregnancy the spiral arteries dilate to 5 to 10 times their normal size and develop into large uteroplacental arteries that can deliver large quantities of blood to the developing fetus in preclampsia these utero placental arteries become fibrous causing them to narrow which means less blood gets the placenta a poorly profused placenta can lead to intrauterine growth restriction and even fetal death in severe cases this hypo perused placenta starts releasing pro-inflammatory proteins these then get into the mother's circulation and cause the endothelial cells that line her blood vessels to become dysfunctional endothelial cell dysfunction causes Vaso constriction or narrowing of the blood vessels and also affects the kidney in a way that makes them retain more salt both of which result in hypertension when diagnosing preclampsia hypertension is defined as a systolic blood pressure of 140 mm of mercury or greater or diastolic blood pressure of 90 mm of mercury or greater in severe preclampsia systolic blood pressure can be 160 mm of mercury or greater and diastolic pressure can be 110 mm of mercury or greater these extreme blood pressures can lead to a hemorrhagic stroke or placental abruption which is when the placenta detaches prematurely from the uterine wall now there can also be local areas of vasospasm which means that less blood might reach certain parts of the body for example reduced blood flow to the kidneys which are particularly susceptible can cause glomular damage leading to oliguria which is abnormally low amounts of urine as well as protein UA normally the glami the kidney do a pretty good job of preventing protein from spilling into the urine so protein UA can be a sign of glomerular damage and is classically seen in preeclampsia reduced blood flow to the retina can cause blur Vision the sensation of seeing flashing lights and the development of a scotoma a skotoma is when a small part of the visual field has slightly worse visual Acuity which is kind of like having a blurry spot on your computer monitor reduced blood flow to the liver can cause severe liver injury and swelling which can cause an elevation in liver enzymes and stretches out the capsule around the liver stretching of the liver capsule typically causes right upper quadrant pain or epigastric pain which is one of the Cardinal symptoms of severe preclampsia endothelial cell injury also leads to the formation of lots of tiny thrombi in the microvasculature which is a process that uses up massive amounts of platelets having all these tiny blood clots in the blood is a little like having dozens of Boulders in the middle of a fast moving River it becomes treacherous for red blood cells to navigate through and before long they slam up against a clot and get destroyed which is a process called hemolysis together these make up the help syndrome H for hemolysis E for elevated liver enzymes and LP for low platelets help syndrome develops in about 10 to 20% of women with severe preclampsia or eclampsia finally endothelial injury increases vascular permeability which is when water is allowed to slip out of blood vessels between neighboring endothelial cells and get into the tissues because there's also a loss of protein from the blood due to the protein Uria even more fluid moves from the blood vessels into the tissues and this causes generalized EMA which is often seen in the legs the face and the hands pulmonary edema which can cause cough in shortness of breath and cerebral edema which can cause headache confusion and seizures and these seizures are what define the onset of eclampsia because all the problems of preclampsia and eclampsia stem from placental dysfunction the ultimate treatment is delivery of the fetus and placenta the decision to induce delivery depends heavily on the gestational age of the fetus as well as the severity of the disease and how it's affecting both maternal and Fetal health if the onset of symptoms comes after delivery then the goal is to manage the symptoms which slowly subside on their own additional measures are aimed at managing any end organ damage by offering supplemental oxygen as well as medication to manage seizures and other complications like stroke or placental abruption all right as a quick recap preclampsia is a disorder that happens after 20 weeks gestation and up to 6 weeks following delivery it's defined by a new onset of hyper tension and protein UA but can affect a lot of organs particularly the kidneys eyes liver and brain eclampsia is diagnosed when a patient with preclampsia develops seizures