Definition, Differentiation, and Risk factors of Pre-eclampsia
Definition:
➧ Pre-eclampsia is a multi-systemic disease unique to human pregnancy.
➧ The term pre-eclampsia refers to the new onset of hypertension (≥140/90 mmHg) and proteinuria after 20 weeks of gestation in previously normotensive, non-proteinuric women i.e. there is an involvement of one or more organ systems.
➧ There is a resolution of the disease by three months postpartum i.e. it is specifically a complication of pregnancy.
➧ Delivery of the baby and removing the placenta is currently the only definitive way of curing the condition.
➧ The disease is responsible for considerable morbidity and mortality, complicating 5-8% of pregnancies.
➧ With its systemic vasoconstriction, intravascular volume and protein depletion, and simultaneous retention of extravascular sodium and water, pre-eclampsia is of particular concern to anesthesiologists.
➧ In addition to individual organ dysfunction, abnormalities in coagulation and edema of the brain, larynx, and lungs may occur.
Atypical Pre-eclampsia:
➧ Atypical cases arise at less than 20 weeks of gestation and over 48 hours after delivery and have signs and symptoms of pre-eclampsia without typical hypertension or proteinuria.
➧ The condition of pre-eclampsia should be considered, in the absence of proteinuria, when gestational hypertension is present in combination with persistent symptoms or when laboratory tests yield abnormal results.
➧ Pre-eclampsia should be considered in any pregnant woman with a severe headache or new-onset epigastric pain.
➧ Under extremely rare circumstances, pre-eclampsia may develop before 20 weeks of gestation in the setting of a hydatidiform mole, multiple pregnancies, fetal or placental abnormalities, antiphospholipid syndrome, or severe renal disease.
Differentiation of Pre-eclampsia:
➧ Pre-eclampsia is classified within the broad category of hypertensive diseases of pregnancy:
1- Pre-existing or chronic hypertension: is present before and often during pregnancy.
2- Gestational hypertension: is defined as hypertension arising after 20 weeks of gestation, without any other organ system involvement.
3- Hypertension in pregnancy may be caused by a variety of different pathologies; these include renal disease, pheochromocytoma, drug usage such as cocaine and amphetamines, and cardiovascular diseases such as coarctation, subclavian stenosis, aortic dissection, and vasculitis.
➧ Other forms of severe hepatic dysfunction in pregnancy need to be differentiated from pre-eclampsia:
1- Acute fatty liver of pregnancy: is a rare condition of pregnancy, which is not associated with hypertension.
2- Hemolytic Uremic Syndrome (HUS) ⁄ Thrombotic Thrombocytopenic Purpura (TTP): should be differentiated from HELLP syndrome, as treatment interventions differ significantly. HUS ⁄ TTP is a clinical diagnosis defined by the presence of a pentad of features; microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms and signs, renal function abnormalities, and fever.
Risk factors:
1- Nulliparity
2- Multifetal gestations
3- Previous history of pre-eclampsia
4- Obesity
5- Diabetes Mellitus
6- Vascular and connective tissue disorders like systemic lupus erythematosus and antiphospholipid antibodies
7- Age >35 years at first pregnancy
8- Smoking
9- African-American race
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