Pre-eclampsia/Eclampsia

Abstract

Pre-eclampsia is a multifactorial and multisystemic disease specific to gestation. It is classically diagnosed by the presence of hypertension associated with proteinuria manifested in a previously normotensive pregnant woman after the 20th week of gestation. Pre-eclampsia is also considered in the absence of proteinuria if there is target organ damage. The present review takes a general approach focused on aspects of practical interest in the clinical and obstetric care of these women. Thus, it explores the still unknown etiology, current aspects of pathophysiology and of the diagnosis, the approach to disease prediction, its adverse outcomes and prevention. Management is based on general principles, on nonpharmacological and on pharmacological clinical treatment of severe or nonsevere situations with emphasis on the hypertensive crisis and eclampsia. Obstetric management is based on preeclampsia without or with signs of clinical and/or laboratory deterioration, stratification of gestational age in < 24 weeks, between 24 and less than 34 weeks, and ≥ 34 weeks of gestation, and guidance on route of delivery. An immediate puerperium approach and repercussions in the future life of pregnant women who develop preeclampsia is also presented.

The WHO Safe Childbirth Checklist implementation: impact on the prescription of magnesium sulphate through a one-year longitudinal study

“…Similar caesarean rates in women with PE have been reported by other studies conducted in developing countries [23]. However, PE is not considered an absolute indication for caesarean delivery [13], and caesarean rates fluctuate greatly between and within countries [24]. The high rate found in the current study is probably not medically justified, and is not exclusively related to cases of PE.…”

“…The International Society for the Study of Hypertension in Pregnancy (ISSHP) has made subsequent recommendations to this goal [5,6]. The Brazilian guidelines use these same international recommendations [13]. However, it is not clear whether health professionals are following the recommendations and using MgSO 4 properly.…”

Uterine vascular resistance and other maternal factors associated with the risk of developing hypertension during pregnancy

“…Arterial hypertension during pregnancy is an important cause of perinatal morbidity and mortality. Although its pathophysiology has not been fully clarified, its etiology is believed to be multifactorial, with an unlikely possibility that a single theory can explain all the cases observed (1). Endothelial factors linked to reduced uterine vascular resistance are strongly correlated with the development of gestational hypertension (2,3).…”

Hypertensive Disorders: Prevalence, Perinatal Outcomes and Cesarean Section Rates in Pregnant Women Hospitalized for Delivery

“…6 The main maternal complications in PE are eclampsia, coagulopathy (disseminated intravascular coagulation), stroke, pulmonary edema, severe renal failure, liver infarction or hemorrhage, myocardial infarction, retinal injury, placental abruption and death. 1,[5][6][7][8] Eclampsia affects $ 3.2% of patients suffering from PE with severe features. 6,9 It occurs in a ratio of 1/2000 deliveries in developed countries and from 1/100 to 1/1,700 deliveries in developing countries.…”