From the Research
Introduction to Preeclampsia
Preeclampsia is a multisystem disorder of human pregnancy characterized by new-onset hypertension after the 20th week of gestation, along with evidence of maternal organ failure 1. It is a serious pregnancy-specific medical condition that remains a major cause of maternal and fetal morbidity and mortality 2.
Pathogenesis of Preeclampsia
The pathogenesis of preeclampsia is multifactorial, involving placental, vascular, renal, and immunological dysfunction 1. It is believed to be caused by abnormal placentation, leading to the release of antiangiogenic markers, such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng) 3. These markers result in endothelial dysfunction, vasoconstriction, and immune dysregulation, which can negatively impact every maternal organ system and the fetus.
Clinical Presentation of Preeclampsia
Preeclampsia presents with hypertension and a variety of organ failures, including malfunction of kidneys, liver, and lungs 4. The clinical syndrome may also involve systemic organ dysfunction, such as cerebral, hepatic, and clotting functions 5.
Treatment and Management of Preeclampsia
The only definitive treatment for preeclampsia is delivery of the baby and placenta 2, 4. For women with mild preeclampsia in the preterm phase of pregnancy, expectant management is generally indicated to improve fetal maturity, often requiring maternal medical treatment 4. Low-dose aspirin is recommended for prophylaxis in high-risk populations 3.
Long-term Consequences of Preeclampsia
Preeclampsia has lasting effects for both mother and child, resulting in increased susceptibility to hypertension and chronic kidney disease 1. It also increases cardiovascular risk in later life, making it essential to monitor and manage women with a history of preeclampsia 4.
Key Considerations
- Preeclampsia is a serious pregnancy-specific medical condition that requires prompt diagnosis and treatment.
- The only definitive treatment is delivery of the baby and placenta.
- Expectant management may be indicated for women with mild preeclampsia in the preterm phase of pregnancy.
- Low-dose aspirin is recommended for prophylaxis in high-risk populations.
- Women with a history of preeclampsia require long-term monitoring and management to reduce cardiovascular risk.
Differential Diagnosis
Preeclampsia must be differentiated from other conditions that present with hypertension and organ dysfunction, such as chronic hypertension, kidney disease, and liver disease.
Caveats
- Preeclampsia can be a complex and challenging condition to manage, requiring a multidisciplinary approach.
- Women with a history of preeclampsia require close monitoring and management to reduce the risk of long-term complications.