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Preeclampsia
The following section is entitled “Preeclampsia”. This section familiarizes the medical provider with the diagnostic features and medical management of preeclampsia. The section begins with a learner handout with space for the learner to make their own notes. The learner handout is followed by the teaching script for the educator. Relevant cases for discussion and a bibliography of articles related to preeclampsia and chronic hypertension in pregnancy can be found at the end of this section.

PREECLAMPSIA

PREECLAMPSIA / PREGNANCY INDUCED HYPERTENSION

Incidence
• Preeclampsia complicates at lease 10% of first pregnancies

Etiology
• The etiology of preeclampsia is unknown but may be related to abnormal placentation.

Obstetric Medicine Curriculum Learner Handout Preeclampsia (Page 1)

PREECLAMPSIA

Pathophysiology
• • Preeclampsia most commonly presents in the second half of pregnancy. It is a multisystem disease associated with diffuse vasospasm and endothelial damage.

Pathophysiology
• Pathology demonstrates areas of endothelial swelling, edema, micro-infarctions and microhemorrhages in effected organs.

Risk Factors
• first pregnancy • new mailings • younger than 18 and older than 35 • prior history • family history Obstetric Medicine Curriculum Learner Handout Preeclampsia (Page 2)

• multiple gestations • hydatidiform mole • hydrops • triploidy

PREECLAMPSIA

Risk Factors
• • • • • chronic hypertension diabetes renal disease SLE thrombophilias (especially APLA) • obesity

Diagnosis
• Though important manifestations of the disease, hypertension, proteinuria, and edema are not essential to the diagnosis of preeclampsia. • The likelihood of preeclampsia increases when more elements of the disease are present.

Symptoms • • • • headache visual disturbances epigastric or RUQ discomfort edema/rapid weight gain

Obstetric Medicine Curriculum Learner Handout Preeclampsia (Page 3)

PREECLAMPSIA

Signs
• • • • • hypertension retinal vasospasm hepatic tenderness facial and hand edema clonus

Laboratory Manifestations
• • • • proteinuria elevated creatinine elevated uric acid elevated liver enzymes • • • • elevated hemoglobin thrombocytopenia elevated PT and PTT microangiopathic hemolytic anemia

Life Threatening Manifestations
• seizures • cerebral hemorrhage • renal failure • hepatic failure • liver hematoma with hepatic failure Obstetric Medicine Curriculum Learner Handout Preeclampsia (Page 4)

• DIC • pulmonary edema • ventricular dysfunction • placental abruption

PREECLAMPSIA

Fetal Effects
• Preeclampsia has significant adverse fetal effects including decreased amniotic fluid levels, decreased fetal growth, placental abruption, and intrauterine fetal demise.

Treatment
• When preeclampsia is dianosed, it is always in the mother’s interest to deliver her baby; therefore, any delay in delivery must be because of uncertainty about the diagnosis or immaturity of the fetus.

Treatment
• • • • The use of an anticonvulsant to prevent seizures should be considered. Magnesium sulfate is most commonly used. Keep blood pressure below 180 systolic and 110 diastolic. Minimize fluids. Monitor patient and labs closely as status can deteriorate rapidly. Preeclampsia (Page 5)

Obstetric Medicine Curriculum Learner Handout

PREECLAMPSIA

Treatment • The patient with Preeclampsia can worsen or even initially present postpartum.

Obstetric Medicine Curriculum Learner Handout Preeclampsia (Page 6)

PREECLAMPSIA
Teaching Script

Preeclampsia and pregnancy induced hypertension (PIH) are often used as interchangeable terms. Some clinicians are more strict in their definitions and use the term PIH to refer to only those patients with isolated hypertension occurring during pregnancy. These clinicians reserve the term preeclampsia for pregnant women with hypertension occurring in association with manifestations such as proteinuria, edema and elevated...