Preeclampsia

Excerpt

Hypertensive disorders of pregnancy constitute a leading cause of maternal and perinatal mortality worldwide. Preeclampsia, with or without severe features, is a disorder of pregnancy associated with new-onset hypertension, usually with accompanying proteinuria, which occurs most often after 20 weeks of gestation and frequently near term. This disease represents a spectrum of hypertensive disease in pregnancy, beginning with gestational hypertension and progressing to develop severe features, ultimately leading to its more severe manifestations, such as eclampsia and HELLP syndrome. This disease encompasses 2% to 8% of pregnancy-related complications, more than 50,000 maternal deaths, and over 500,000 fetal deaths worldwide. Early diagnosis and prompt management are essential to preventing both maternal and neonatal complications through symptomatic management and delivery planning.

The parameters for initial identification of hypertension in the context of pregnancy-induced hypertension constituting the "mild range" are specifically defined as a systolic blood pressure (SBP) of 140 mm Hg or more or diastolic blood pressure (DBP) of 90 mm Hg or more on 2 occasions at least 4 hours apart; or shorter interval timing in cases of "severe range" hypertension with SBP of 160 mm Hg or more or DBP of 110 mm Hg or more, all of which must be identified after 20 weeks of gestation. Such criteria identified before 20 weeks of gestation would be defined as pre-existing essential hypertension or "chronic hypertension."

The initial presentation of preeclampsia typically arises in near-term pregnancies. The progression of pregnancy-induced hypertension (PIH) is presently understood to first begin with gestational hypertension, where there is new-onset hypertension, and then followed by more severe forms of hypertension with specific laboratory and clinical criteria to be discussed further. It is important to acknowledge, however, that the understanding of the pathophysiology of PIH has improved, and its diagnostic criteria have evolved, resulting in the classical triad of hypertension, edema, and proteinuria transitioning to hypertension and organ dysfunction (ie, renal, hepatic, neurologic, hematological, or uteroplacental.) Nonetheless, the most recent definitions endorsed by governing bodies such as the American College of Obstetrics and Gynecology (ACOG) have largely been based on consensus and expert opinion, not primary research.