What is preeclampsia?

From the Guidelines

Preeclampsia is a potentially life-threatening pregnancy complication characterized by high blood pressure and damage to other organ systems, typically occurring after 20 weeks of gestation, with a prevalence of 5-7% of pregnancies worldwide 1.

Definition and Prevalence

Preeclampsia is defined as new-onset hypertension (or worsening hypertension in patients with existing hypertension) after 20 weeks of gestation, combined with proteinuria or other signs and symptoms involving multiple organ systems 1. The exact cause of preeclampsia remains unclear, but it is associated with substantial health risks during and after pregnancy, including maternal and fetal complications.

Risk Factors and Symptoms

Risk factors for preeclampsia include first pregnancy, multiple pregnancy, family history, age over 40, obesity, and pre-existing conditions like hypertension or diabetes 1. The main symptoms of preeclampsia include:

• High blood pressure (above 140/90 mmHg)
• Protein in urine (proteinuria)
• Severe headaches
• Vision changes
• Upper abdominal pain
• Nausea or vomiting
• Decreased urine output
• Swelling in the face and hands

Treatment and Management

Treatment of preeclampsia depends on severity and gestational age, but often includes:

• Blood pressure medications like labetalol or methyldopa
• Close monitoring
• Delivery of the baby if the condition becomes severe
• Magnesium sulfate to prevent seizures in severe cases 1. The only definitive cure for preeclampsia is delivery, which is why healthcare providers carefully balance the risks of early delivery against the risks of continuing the pregnancy with preeclampsia.

Global Impact and Health Disparities

Preeclampsia is a significant contributor to maternal and fetal morbidity and mortality worldwide, with hypertensive disorders responsible for 14% of maternal deaths globally 1. In the United States, hypertensive disorders of pregnancy are responsible for 7.8% of maternal deaths, with Black women at increased risk due to systemic racism and discrimination 1. Improving outcomes related to preeclampsia requires ensuring access to quality care, addressing systemic and community factors, and investing in innovative care delivery models.

From the Research

Definition of Preeclampsia

• Preeclampsia is a multisystemic disorder characterized by new onset of hypertension and proteinuria arising after 20 weeks of gestation in a previously normotensive woman 2.
• However, the American College of Obstetricians and Gynecologists has stated that proteinuria is no longer required for the diagnosis of preeclampsia 2.

Pathophysiology of Preeclampsia

• The cytotrophoblast fails to remodel spiral arteries, leading to hypoperfusion and ischemia of the placenta 2.
• The ischemic placenta releases factors that provoke a generalized maternal endothelial dysfunction, which is responsible for the symptoms and complications of preeclampsia 2.

Symptoms and Complications of Preeclampsia

• Hypertension, proteinuria, renal impairment, thrombocytopenia, epigastric pain, liver dysfunction, hemolysis-elevated liver enzymes-low platelet count (HELLP) syndrome, visual disturbances, headache, and seizures 2.
• Severe hypertension, thrombocytopenia, liver transaminases above twice the normal values, HELLP syndrome, renal failure, persistent epigastric or right upper quadrant pain, visual or neurologic symptoms, and acute pulmonary edema are all severity criteria 2.

Treatment of Preeclampsia

• The only curative treatment remains placenta and fetus delivery 2.
• Medical treatment depends on the severity of preeclampsia and relies on antihypertensive medications and magnesium sulfate 2, 3, 4.
• Magnesium sulfate is the drug of choice for the prevention and control of maternal seizures in patients with severe preeclampsia or eclampsia during the peripartum period 4.

Management of Severe Preeclampsia

• Identification of high-risk patients, optimisation of antenatal care, early intervention, and the identification and early management of complications 3.
• Oral anti-hypertensive agents, including labetalol, nifedipine, and methyldopa, should be tried first, followed by intravenous anti-hypertensives if necessary 3.
• Delivery of the baby is the definitive management of severe preeclampsia 3.

Long-term Risks of Preeclampsia

• Preeclampsia is a risk factor for developing cardiovascular disease later in life, and therefore mandates long-term follow-up 2, 5.
• Substantial long-term cardiovascular and metabolic risks to mothers and children associated with gestational hypertensive disorders, in particular, preterm preeclampsia 5.