Preeclampsia and eclampsia
Preeclampsia is a serious pregnancy complication that typically arises after the 20th week of gestation and is characterized by high blood pressure and the presence of protein in the urine. If left untreated, it can progress to eclampsia, a more severe condition marked by seizures or coma. The exact causes of preeclampsia and eclampsia remain largely unknown, though several risk factors have been identified, including being a first-time mother, advanced maternal age, obesity, and certain pre-existing health conditions like diabetes and hypertension. Symptoms of preeclampsia may include headaches, abdominal pain, and vision problems, while eclampsia can lead to serious organ damage and potentially fatal outcomes.
Treatment options for preeclampsia often involve strict bed rest, medication to manage blood pressure, and, in severe cases, the delivery of the baby. While early diagnosis and treatment can improve outcomes, women who experience these conditions face a higher risk of complications for both themselves and their infants. Ongoing research seeks to uncover the underlying mechanisms contributing to preeclampsia, with a focus on factors such as genetics and the role of the placenta. Awareness of this condition is crucial for the health and safety of both mother and child during pregnancy.
Preeclampsia and eclampsia
ANATOMY OR SYSTEM AFFECTED: Circulatory system, endocrine system, kidneys, nervous system, reproductive system
DEFINITION: Preeclampsia is a serious complication of pregnancy, occurring any time from the middle stages of pregnancy to just after birth, characterized by hypertension and proteinuria; eclampsia is a potentially fatal condition, likewise occurring any time from the middle stages of pregnancy to just after birth, characterized by seizures or coma that has no other apparent cause
CAUSES: Unknown; risk factors include first pregnancy, personal or family history of disorder, age younger than eighteen or older than forty, more than one fetus, obesity, and certain diseases (polycystic ovarian syndrome, diabetes, kidney disease, hypertension, autoimmune disorders)
SYMPTOMS: For preeclampsia, high blood pressure, proteinuria, headaches, abdominal pain, vision problems; for eclampsia, convulsive seizures, organ damage, sometimes coma or death
DURATION: Chronic during pregnancy
TREATMENTS: Strict bed rest, balanced salt solution, sedatives, blood pressure medications, magnesium sulfate, diazepam, diuretics, delivery of baby as soon as possible
Causes and Symptoms
Preeclampsia, also known as toxemia of pregnancy or pregnancy-induced hypertension, is a serious condition that was responsible for more than fifty thousand maternal deaths and five hundred thousand infant deaths worldwide, according to a 2023 report by the online medical database StatPearls. The condition can arise any time from the twentieth week of pregnancy to the first week after birth. A woman is diagnosed with if she has elevated in addition to proteinuria. The blood pressure of preeclampsia patients generally exceeds 140/90; however, an increase in systolic pressure by 30 or an increase in diastolic pressure by 15—even if the 140/90 cutoff is not reached—when accompanied by other characteristic symptoms is sufficient for a diagnosis of preeclampsia. Headaches, abdominal pain, and visual disturbances may accompany the disorder. Patients who have normal blood pressure prior to pregnancy but suffer from increased blood pressures as described above are said to suffer from pregnancy-induced (PIH).
Preeclampsia may lead to HELLP syndrome, characterized by hemolytic anemia, elevated liver enzymes, and a low platelet count. HELLP syndrome typically occurs in the last trimester, with women complaining of nausea, vomiting, and abdominal pain. In severe cases, the syndrome leads to intravascular blood clotting, kidney failure, liver failure, respiratory failure, failure, and death.
Eclampsia, the most dangerous of preeclampsia, is characterized by convulsive seizures that may lead to coma or death. Organ damage, particularly in the kidneys, liver, brain, and placenta, may occur.
The risk of preeclampsia is higher in women experiencing their first pregnancy, or their first pregnancy with a different partner; women with a personal or family history of the disorder; women younger than eighteen or older than forty; those carrying two or more fetuses; women with a greater than 30; women with polycystic ovarian syndrome; or women with other conditions such as diabetes, kidney disease, hypertension, or autoimmune disorders. Recent evidence indicates that the existence of high blood pressure, obesity, or diabetes prior to pregnancy is likely to predispose a pregnant woman to preeclampsia.
The cause of preeclampsia and is not usually known. Kidney disease or other conditions that raise blood pressure may trigger the condition. Genetics may be important. An abnormal maternal to fetal tissue may also play a role in triggering preeclampsia and eclampsia. The functioning of the placenta (which develops from the known as the chorion) seems to play an important part in the development of preeclampsia. If it becomes hypoxic (oxygen-deprived), the is believed to release as-yet-unidentified toxic substances into the maternal circulation, leading to the development of preeclampsia.
Treatment and Therapy
If caught early, mild cases of preeclampsia can be treated with strict bed rest, either at home or in the hospital if the condition does not improve. In more severe cases, bed rest should be accompanied by intravenous (IV) administration of balanced salt solution, such as Ringer’s solution; sedatives; medication to control blood pressure; and, if necessary, medication to control seizures, such as magnesium sulfate. Diuretics may also be required. Once the woman’s condition is stabilized, delivery should be accomplished, either vaginally or by cesarean section. Eclampsia and HELLP syndrome should be treated in the same way. If magnesium sulfate fails to control seizures, then drugs such as diazepam should be administered. While delivery of the is often essential for the survival of both the mother and the baby, it frequently results in extremely premature infants who then face a large cadre of challenges associated with their prematurity.
Women treated for preeclampsia and related disorders should be monitored for other symptoms, including headaches, blurred vision, abdominal pain, vaginal bleeding, and loss of fetal heart sounds. Symptoms should resolve themselves within six hours after delivery.
Perspective and Prospects
Although preeclampsia was first described as early as the nineteenth century, little progress has been made since in determining its cause. Recent research has focused on a number of potential factors. Among them are genetics, because of the relationship between a family history of the disorder and the risk of developing it. Some researchers have suggested nutrient deficiencies as a cause, but evidence for a nutritional relationship has been equivocal. Hormonal imbalances have been suggested as a cause, as have interruptions of the blood supply to the placenta, responses to fetal tissue or attempts to repair perceived damage to tissue, calcium deficiencies, and a host of other factors, including preexisting conditions such as lupus, diabetes, sickle cell disease, and kidney diseases.
Researchers seeking the cause of preeclampsia have recently focused on the placenta. Deprivation of vascular growth factors, such as vascular endothelial growth factor (VEGF), inhibits vascular development in the placenta, which adversely affects the developing fetus. Abnormal concentrations of VEGF have also been shown to cause damage in the kidney.
With growth factors, hormones, nutrients, or myriad other compounds and conditions possibly playing a role in triggering preeclampsia and eclampsia, it is clear that much more work needs to be done.
Bibliography
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