preeclampsia is a disorder that only
happens in pregnant women and it happens
after 20 weeks gestation and in some
cases develops up to six weeks after
delivery preeclampsia causes new onset
hypertension in proteinuria
which is a marker of kidney damage and
can also cause damage to other organs
like the brain in the liver there can be
a wide range of symptoms for some women
there might be no symptoms or only mild
ones whereas for others it can turn into
a life-threatening illness if a woman
with preeclampsia develops seizures
she's then said to have eclampsia
preeclampsia tends to happen more often
during a first pregnancy in pregnancies
with multiple gestation x' or in
mother's 35 years or older other risk
factors include having hypertension
diabetes obesity or a family history of
preeclampsia alright but why do these
changes happen in preeclampsia and
eclampsia well the exact cause is
unclear but a key pathophysiologic
feature is the development of an
abnormal placenta normally during
pregnancy the spiral arteries dilate to
five to ten times their normal size and
develop into large utero placental
arteries that can deliver large
quantities of blood to the developing
fetus in preeclampsia these utero
placental arteries become fibrous
causing them to narrow which means less
blood gets the placenta a poorly profuse
placenta can lead to intrauterine growth
restriction and even fetal death in
severe cases this hypoperfusion a'
starts releasing pro-inflammatory
proteins these then get into the mother
circulation and cause the endothelial
cells that line her blood vessels to
become dysfunctional endothelial cell
dysfunction causes vasoconstriction or
narrowing of the blood vessels and also
affects the kidneys in a way that makes
them retain more salt both of which
results in hypertension when diagnosing
preeclampsia hypertension is defined as
a systolic blood pressure of a hundred
and forty millimeters of mercury or
greater or diastolic blood pressure of
90 millimeters of mercury or greater in
severe preeclampsia systolic blood
pressure can be a hundred and sixty
millimeters of mercury or greater and
diastolic pressure can be a hundred and
ten millimeters of mercury or greater
these extreme blood pressures can lead
to a hemorrhagic stroke or placental
abruption which is when the placenta
detaches prematurely from the uterine
wall now there can also be local areas
of vasospasm which means that less blood
might reach certain parts of the body
for example reduced blood flow to the
kidneys which are particularly
susceptible can cause glomerular damage
leading to oliguria which is abnormally
low amounts of urine as well as
proteinuria normally the glomeruli the
kidney do a pretty good job of
preventing protein from spilling into
the urine so proteinuria can be a sign
of glomerular damage and is classically
seen in preeclampsia reduce blood flow
to the retina can cause blurred vision
the sensation of seeing flashing lights
and the development of a scotoma Aska
Toma is when a small part of the visual
field has slightly worse visual acuity
which is kind of like having a blurry
spot on your computer monitor reduced
blood flow to the liver can cause severe
liver injury and swelling which can
cause an elevation in liver enzymes and
stretches out the capsule or on the
liver stretching of the liver capsule
typically causes right upper quadrant
pain or epigastric pain which is one of
the cardinal symptoms of severe
preeclampsia endothelial cell injury
also leads to the formation of lots of
tiny thrombi in a micro vasculature
which is a process that uses up massive
amounts of platelets having all these
tiny blood clots in the blood is a
little like having dozens of boulders in
the middle of a fast-moving river it
becomes treacherous for red blood cells
to navigate through and before long they
slam up against a clot and get destroyed
which is a process called hemolysis
together these make up the help syndrome
age for hemolysis el4 elevated liver
enzymes an LP for low platelets helped
syndrome develops in about 10 to 20
percent of women with severe
preeclampsia Ori clamp Xia finally
endothelial injury increases vascular
permeability which is when water is
allowed to slip out of blood vessels
between neighboring endothelial cells
and get into the tissues because there's
also a loss of protein from the blood
due to the proteinuria even more fluid
moves from the blood vessels into the
tissues and this causes generalized
edema which is often seen in the legs
the face in the hands pulmonary edema
which can cause coughing shortness of
breath and cerebral edema which can
cause headache confusion and seizures
and these seizures I would define the
onset of eclampsia because all the
problems of preeclampsia and eclampsia
stem from placental dysfunction the
ultimate treatment is delivery of the
fetus in placenta the decision to induce
delivery depends heavily on the
gestational age of the fetus as well as
the severity of the disease and how it's
affecting both maternal and fetal health
if the onset of symptoms comes after
delivery then the goal is to manage the
symptoms which slowly subside on their
own additional measures are aimed at
managing any end organ damage by
offering supplemental oxygen as well as
medication to manage seizures and other
complications like stroke or placental
abruption all right as a quick recap
preeclampsia is a disorder that happens
after 20 weeks gestation and up to 6
weeks following delivery is defined by a
new onset of hypertension and
proteinuria but can affect a lot of
organs particularly the kidneys eyes
liver and brain a clamp C is diagnosed
when a patient with preeclampsia
developed seizures
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