From the Research
Introduction to Preeclampsia
Preeclampsia is a multisystem disorder of human pregnancy with a genetic predisposition, characterized by hypertension and a variety of organ failures, including malfunction of kidneys, liver, and lungs 1, 2, 3, 4, 5.
Pathophysiology
The pathophysiology of preeclampsia involves abnormal placentation, leading to the release of antiangiogenic markers, such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), which cause endothelial dysfunction, vasoconstriction, and immune dysregulation 3, 5. This results in widespread maternal endothelial cell damage, leading to organ hypoperfusion and dysfunction 1.
Clinical Presentation
The clinical presentation of preeclampsia is highly variable, but hypertension and proteinuria are usually seen 1, 2, 3, 4, 5. The disease can affect multiple organ systems, including the kidneys, liver, lungs, and brain, and can lead to significant maternal and perinatal morbidity and mortality.
Treatment and Management
The only definitive treatment for preeclampsia is delivery of the placenta, either through induction of labor or cesarean section 1, 2, 3, 4. For women with mild preeclampsia, expectant management may be indicated to improve fetal maturity, often requiring maternal medical treatment 2. Low-dose aspirin is recommended for prophylaxis in high-risk populations 3.
Treatment Options
- Delivery of the placenta: the only definitive treatment for preeclampsia
- Expectant management: for women with mild preeclampsia to improve fetal maturity
- Low-dose aspirin: for prophylaxis in high-risk populations
- Management of high blood pressure and potential complications: according to current treatment guidelines
Dosing Information
- Low-dose aspirin: the exact dosage is not specified in the provided evidence, but it is generally recommended to take 81-100 mg per day for prophylaxis in high-risk populations.
Differential Diagnosis and Caveats
Preeclampsia can be difficult to diagnose, as the clinical presentation is highly variable and can resemble other conditions, such as chronic hypertension or kidney disease 1, 5. A thorough medical history, physical examination, and laboratory tests are necessary to confirm the diagnosis and rule out other potential causes of hypertension and organ dysfunction.
Conclusion
Preeclampsia is a complex and multifactorial disease that requires a comprehensive understanding of its pathophysiology, clinical presentation, and treatment options. Further research is needed to clarify the underlying mechanisms and identify potential therapeutic targets for improved treatment and outcomes.