Pre-eclampsia and eclampsia: mechanisms, organ effects, and treatment
THE CONTEXT
This passage links endothelial dysfunction and vasospasm to clinical manifestations and summarizes classification and management.
Classification
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Pregnancy-induced hypertension includes gestational hypertension, pre-eclampsia, and eclampsia.
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The source describes early pre-eclampsia as occurring before 34 weeks and late pre-eclampsia as occurring after 34 weeks; late-onset disease often has a favorable outcome.
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Pre-eclampsia may have severe or non-severe features. Untreated disease can cause maternal and fetal complications.
Endothelial dysfunction and clinical manifestations
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Endothelial dysfunction increases capillary permeability, producing manifestations such as ascites, pulmonary edema, proteinuria, and pleural effusion.
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Associated coagulation activation includes thrombocytopenia, DIC, and HELLP syndrome. Visual disturbances and retinal hemorrhage may also occur.
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Vasoconstriction produces hypertension, while diminished organ perfusion produces oliguria and IUGR.
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Increased vascular permeability produces edema and proteinuria; endothelial damage is associated with thrombocytopenia and HELLP syndrome.
Organ effects of vasospasm
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Uteroplacental involvement is associated with IUGR and placental abruption.
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Renal involvement produces proteinuria, oliguria, and renal failure.
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Liver involvement includes necrosis, subcapsular hematoma, and elevated AST and ALT.
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Neurological involvement includes seizures, cortical blindness, and posterior reversible encephalopathy syndrome involving the parietal and occipital lobes.
Prediction and prevention described in the source
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The passage states that no screening test is helpful, although high-risk factors may identify an individual at risk.
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Listed preventive interventions include a high-protein, low-salt diet, antithrombotic agents, low-dose aspirin, calcium, magnesium, zinc, and vitamins E and C.
Management and eclamptic seizures
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Management of eclampsia and severe pre-eclampsia includes control of fits and hypertension.
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Magnesium sulfate is used to control fits through intramuscular or intravenous regimens.
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First-line antihypertensives listed are labetalol, hydralazine, and nifedipine. This passage gives blood pressure targets of 140–160 mm Hg systolic and 90–100 mm Hg diastolic.
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Delivery is the only definitive treatment for pre-eclampsia.
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Acute fulminant pre-eclampsia carries a high risk of eclampsia, and prophylactic anticonvulsant therapy is recommended.
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Eclampsia is a complication of pre-eclampsia characterized by grand mal seizures and is a significant cause of maternal death.
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Eclamptic convulsions have four stages: premonitory, tonic, clonic, and coma.