{"id":805,"date":"2021-06-06T23:09:00","date_gmt":"2021-06-07T03:09:00","guid":{"rendered":"https:\/\/www.emboardbombs.com\/?p=805"},"modified":"2023-07-16T12:52:10","modified_gmt":"2023-07-16T16:52:10","slug":"2021-6-3-preeclampsia-b2hxx","status":"publish","type":"study-guide","link":"https:\/\/www.emboardbombs.com\/study-guide\/2021-6-3-preeclampsia-b2hxx\/","title":{"rendered":"Preeclampsia"},"content":{"rendered":"

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: <\/strong>emrapidbombs.supercast.com<\/strong><\/a><\/p>\n

Author: Sam Hopp, MSIII<\/p>\n

Peer-Reviewer: Blake Briggs, MD; Travis Smith, DO; Rodney Briggs, MD<\/p>\n

Introduction\u00a0<\/strong><\/p>\n

Preeclampsia is a feared, multisystem condition consisting of hypertension (HTN) and end-organ dysfunction with or without proteinuria in the last half of pregnancy. It can also occur in the immediate postpartum period. 90% of patients present >34 weeks gestational age and have good maternal and fetal outcomes, but the mother and child are still at increased risk for serious morbidity and mortality. 10% of cases present <34 weeks and carry higher risks of preterm birth. Those with preeclampsia have a risk of cardiovascular and renal disease after pregnancy.<\/p>\n

In total, hypertensive disorders complicate ~ 10% of pregnancies and are classified into chronic HTN (1%), gestational HTN w\/o proteinuria (5-6%), preeclampsia (5%), and eclampsia.1\u00a0Being familiar with these conditions is not only important because they will be tested on the written and oral boards, but because they account for over 50,000 maternal deaths and 500,000 fetal deaths worldwide. Let\u2019s start with some basics.<\/p>\n

Definitions<\/strong>:\u00a0These are annoying to remember but easily testable. You must know these definitions to best care for your pregnant patients. In pregnancy, HTN is defined as \u2265140 \/ \u226590. Severe HTN is \u2265160 \/ \u2265110.<\/p>\n

Chronic HTN of pregnancy<\/em>: HTN diagnosed\u00a0before\u00a0<\/strong>pregnancy or before 20 weeks\u2019 gestation on at least 2 occasions.2\u00a0Remember that BP \u2265120\/80 is abnormal and can be associated with increased risk of preeclampsia.<\/p>\n

Gestational HTN<\/em>:\u00a0New onset<\/strong>\u00a0of SBP \u2265140 mmHg or DBP \u226590mmHg\u00a0after\u00a0<\/strong>20 weeks\u2019 gestation in a previously normotensive woman on two occasions at least four hours apart or shorter intervals. Blood pressures of\u00a0>160 \/\u00a0>110 are high risk for risk of severe preeclampsia.2\u00a010-25% of these patients will develop signs and symptoms of preeclampsia.<\/p>\n

Preeclampsia<\/em>:\u00a0New onset<\/strong>\u00a0of HTN and proteinuria or new onset HTN and end-organ dysfunction with or without proteinuria\u00a0after<\/strong>\u00a020 weeks of gestation or postpartum in a previously normotensive woman.\u00a03<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u2265 2+ protein on urine dipstick, proteinuria >0.3 g in 24-hour specimen or protein\/creatinine ratio > 0.3<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Platelet count < 100,000<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Serum creatinine > 1.1 or >2x baseline<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Liver transaminases at least 2x upper limit normal<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Pulmonary edema<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0New onset and persistent headache not responding to acetaminophen<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Visual symptoms (ex. blurred, flashing lights, sparks, scotomata).3*<\/p>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Persistent right upper quadrant or epigastric tenderness, or chest pain<\/p>\n

*In rare cases, HTN and proteinuria may be absent, in such cases, any one of the following symptoms may be used to make the diagnosis: thrombocytopenia, renal insufficiency, pulmonary edema, impaired liver function, or new-onset headache with or without visual disturbance.<\/em><\/p>\n

Preeclampsia with severe features<\/em>: Preeclampsia with severe HTN and\/or specific signs of significant end-organ dysfunction.<\/p>\n

HELLP<\/em>: Variant of preeclampsia with severe features characterized by hypertension plus hemolysis, elevated liver enzymes, and low platelets. HTN is not present in a minority of cases.4<\/p>\n

Remember that in normal pregnancy, 30% of women may have dependent foot and ankle edema, but hand and facial edema is \u00a0concerning.<\/p>\n

Eclampsia<\/em>: Preeclampsia + generalized seizures.5<\/p>\n

\"\"<\/figure>\n

Mechanism<\/strong><\/p>\n

Largely unknown but many think it is secondary to an acute arthrosis of decidual \u201cspiral\u201d arteries leading to poor placental perfusion and placental ischemia. This then cascades out of control as the hypoxic placental tissue releases all of those bad free radicals to cause oxidative stress, and unchecked \u201cinflammation.\u201d The release of placental antiangiogenic factors into the maternal blood stream causes widespread vascular dysfunction and the clinical presentation of preeclampsia.7<\/p>\n

Key Risk Factors<\/strong>:\u00a08<\/p>\n