From the Research
Introduction to Preeclampsia
Preeclampsia, also known as pregnancy-induced hypertension, is a complex multisystem disease that occurs during pregnancy, typically after 20 weeks of gestation 1, 2, 3. It is characterized by new-onset hypertension and end-organ dysfunction, often accompanied by proteinuria, maternal organ dysfunction, or uteroplacental dysfunction 3.
Diagnosis of Preeclampsia
The diagnosis of preeclampsia is based on the presence of hypertension and at least one other associated complication, such as proteinuria, maternal organ dysfunction, or uteroplacental dysfunction 3. The traditional hallmarks for the diagnosis of preeclampsia are hypertension and proteinuria, which may occur with or without multisystem dysfunction and fetal involvement 2.
Risk Factors for Preeclampsia
Several risk factors have been identified for the development of preeclampsia, including a prior history of preeclampsia, diabetes, kidney disease, obesity, and high maternal age at pregnancy 1, 2. Women who have had preeclampsia in a previous pregnancy are at increased risk of developing it again in a subsequent pregnancy.
Treatment of Preeclampsia
The only known curative treatment for preeclampsia is termination of pregnancy, either through induction of delivery or cesarean section 1, 3. However, the management of preeclampsia focuses on controlling high blood pressure and preventing complications. Treatment may include:
- Oral anti-hypertensive agents, such as labetalol, nifedipine, and methyldopa, to control blood pressure 4
- Intravenous anti-hypertensives, such as labetalol, hydralazine, and glyceryl trinitrate, if oral agents are ineffective 4
- Magnesium sulphate to prevent seizures 4
- Close monitoring of fluid balance, neurologic status, and other vital signs 4
Prevention of Preeclampsia
While there is no sure way to prevent preeclampsia, daily low-dose aspirin starting before 16 weeks of gestation has been shown to reduce the risk of preterm preeclampsia 3. Women at high risk of developing preeclampsia should be closely monitored and managed by a multidisciplinary team.
Complications and Long-term Consequences
Preeclampsia can have serious complications for both the mother and the baby, including maternal and fetal mortality, preterm birth, and long-term health issues such as cardiovascular disease and diabetes 2, 3. Women who have had preeclampsia are at increased risk of developing these conditions later in life.
Differential Diagnosis and Caveats
Preeclampsia can be difficult to diagnose, and other conditions such as chronic hypertension and kidney disease must be ruled out 2. The diagnosis and management of preeclampsia require careful consideration of the individual patient's risk factors, medical history, and clinical presentation.