Preeclampsia and Eclampsia (Pregnancy-Induced Hypertension)

– Preeclampsia is a disorder occurring between the twentieth week of pregnancy and the first week postpartum characterized by hypertension, proteinuria, and edema. Eclampsia is diagnosed when a woman with preeclampsia develops convulsions or becomes comatose in the absence of any other underlying neurologic disorder.

Causes and Incidence

The cause of preeclampsia and eclampsia is unknown. Preeclampsia occurs in 5% of pregnant women. Primigravidas and women with preexisting cardiovascular conditions, diabetes mellitus, or renal disease are at greatest risk. About 1 in 200 of those individuals diagnosed with preeclampsia develops eclampsia.

Disease Process

An increased sensitivity to angiotensin II develops, followed by vasospasms, which cause increased resistance to vascular flow and increased aterial pressure, with accompanying hemoconcentration.

Symptoms

The primary signs of preeclampsia are a blood pressure of 140/90, or an increase of 15 mm Hg diastolic or 30 mm Hg systolic over the woman’s baseline pressure; and proteinuria and nondependent edema of the hands and face. These signs may be accompanied by a sudden weight gain. Seizure activity or coma (or both) in a woman with preeclampsia is indicative of eclampsia.

Potential Complications

A major complication of preeclampsia is abruptio placentae. Untreated preeclampsia leads to eclampsia, and untreated eclampsia is generally fatal.

Diagnostic Tests

Evaluation is based on the presenting symptoms.

Treatments

Surgery
Delivery for women with severe or unresponsive preeclampsia–vaginal delivery if cervix is ripe, cesarean section if vaginal delivery is unlikely

Drugs
Severe preeclampsia: IV magnesium sulfate to reduce blood pressure, addition of hydralazine if no response occurs; calcium gluconate as an antidote for excess magnesium sulfate; diuretics are contraindicated because they reduce uteroplacental perfusion.

General
Mild preeclampsia: Bed rest, positioned on the left side to increase urinary output and lessen intravascular dehydration and hemoconcentration; increased fluid intake and normal salt intake; close monitoring of blood pressure, daily or every other day.

Severe preeclampsia and eclampsia: immediate hospitalization, IV with balanced salt solution and administration of drugs in preparation for delivery; vital signs and fetal heart tone every 15 minutes; intake and output measurements hourly; monitoring for signs of abruptio placentae, seizure, decrease in consciousness, HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count).