Postpartum care after renal transplantation and overview of pre-eclampsia
THE CONTEXT
The target passage completes postpartum management after renal transplantation and then reviews the defining features and pathological basis of pre-eclampsia.
Postpartum discharge planning
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Before hospital discharge, blood pressure should be stable and lower than 140/90 mm Hg.
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Women with an indication for an angiotensin converting enzyme inhibitor may receive enalapril, which the source describes as safe during breastfeeding.
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Contraceptive advice is mandatory.
Clinical importance and presentation
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Hypertension is the most common medical complication of pregnancy.
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Pre-eclampsia and eclampsia are leading causes of maternal mortality and morbidity in India and worldwide.
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Pre-eclampsia is a syndrome of multiple organ dysfunction peculiar to pregnancy and usually first manifests beyond 20 weeks.
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The passage describes hypertension of 140/90 mm Hg or more, with proteinuria and with or without pathological edema, but explicitly clarifies that proteinuria is no longer required for diagnosis.
Pathological basis
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The exact etiology remains unknown; the basic pathology is endothelial dysfunction and vasospasm.
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The proposed basis is an imbalance between vasodilatory factors, including PGI2, PGE2, VEGF, and nitric oxide, and vasoconstrictors.
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Listed vasoconstrictors include TXA2, ROS, superoxide radicals, lipid peroxides, sFlt-1, and endothelin-1.