Preeclampsia and Eclampsia (Toxemia of Pregnancy)
- Preeclampsia: a disorder of pregnancy occurring after 20 weeks’ gestation characterized by new-onset hypertension (HTN), new-onset proteinuria, ± impaired organ function
- Eclampsia: new-onset grand mal seizure activity with no history of underlying neurologic disease
- Most postpartum cases of preeclampsia and eclampsia occur within 48 hours of delivery but can occur up to 6 weeks postpartum.
Preeclampsia occurs in 5–8% of all pregnancies.
- Predominant age
- Mostly in younger women, primiparous women
- Older (age >40 years) patients with preeclampsia have 4 times the incidence of seizures compared with patients in their 20s.
- 40% of eclamptic seizures occur before delivery; 16% occur >48 hours after delivery.
- Eclampsia is a main cause of perinatal mortality and morbidity (2–8% of all pregnancies).
Etiology and Pathophysiology
- Cause of preeclampsia is becoming clearer.
- Genetic predisposition and abnormal placental implantation
- Angiogenic factors
- Vascular endothelial damage and oxidative stress
- Systemic disorders in eclampsia include the following:
- Cardiovascular: generalized vasospasm
- Hematologic: decreased plasma volume, increased blood viscosity, hemoconcentration, coagulopathy
- Renal: decreased glomerular filtration rate
- Hepatic: periportal necrosis, hepatocellular damage, subcapsular hematoma
- CNS: cerebral vasospasm and ischemia, cerebral edema, cerebral hemorrhage
2 to 4 times increased risk in pregnant women with family history of preeclampsia
- Age >40 years
- Family history of preeclampsia
- Maternal medical problems: diabetes, chronic HTN, chronic renal disease, obesity, systemic lupus erythematosus
- Multiple gestation
- Prior pregnancy with preeclampsia
- In vitro fertilization
- Adequate prenatal care
- Good control of preexisting HTN
- Low-dose aspirin (ASA) (60 to 80 mg):
- Low-dose calcium supplementation has been shown to reduce the risk and severity of preeclampsia in calcium-deficient populations.
Commonly Associated Conditions
Abruptio placentae, placental insufficiency, fetal growth restriction, preterm delivery, fetal demise maternal seizures (eclampsia), maternal pulmonary edema, maternal liver/kidney failure, or maternal death
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