DESCRIPTION

• 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.

EPIDEMIOLOGY

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

RISK FACTORS

• Nulliparity
• 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

GENERAL PREVENTION

• Adequate prenatal care
• Good control of preexisting HTN
• Low-dose aspirin (ASA) (60 to 80 mg): ASA started early after 12 weeks’ gestational age (GA) may lower the risk of developing preeclampsia and the rate of preterm delivery and neonatal death in moderate- to high-risk patients (see “Risk Factors” as mentioned earlier).
• 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