Topic: Preeclampsia and Toxaemias of pregnancy, Management of Post menopausal Syndrome. ‘
Question:Define ‘pre-eclampsia’. Enumerate the risk factors which may lead to this condition? What are the clinical signs and what are its alarming symptoms?
Reference Material-This material is informational alone and is not specifically prepared as an answer for any question. Readers may do their own research before finalising diagnoses according to the characteristics unique to each question. Readers should not proceed without cross-referencing with relevant textbooks as well as standard guidelines available.
Definition: According to the American College of Obstetricians and Gynecologists, preeclampsia is defined as the development of new-onset hypertension (blood pressure >140 mmHg systolic or >90 mmHg diastolic) and either new-onset proteinuria (≥300 mg of protein in a 24-hour urine collection or ≥30 mg/mmol creatinine in a spot urine sample) or end-organ dysfunction after 20 weeks of gestation in a previously normotensive woman.
Risk factors:
– Nulliparity: Preeclampsia risk is higher for first pregnancies.
– Obesity: High body mass index increases risk especially with excess weight gain during pregnancy.
– Diabetes: Both pregestational and gestational diabetes are associated with increased preeclampsia risk.
– Renal disease: Conditions like chronic hypertension, glomerulonephritis,etc. can increase susceptibility.
– Family history: Risk is higher if a mother, sister or daughter had preeclampsia.
– Advanced maternal age: Risk increases with age, especially after 35 years of age.
– Placental abnormalities: Conditions like molar pregnancy, triploidy, etc. can lead to preeclampsia.
Clinical signs:
– Hypertension: Blood pressure greater than 140/90 mmHg on two occasions 4-6 hours apart after 20 weeks of gestation.
– Proteinuria: ≥300 mg of protein in 24-hour urine sample or spot urine protein/creatinine ratio >0.3.
– Edema: Swelling of face, hands and ankles, sudden weight gain.
– Headache: Persistent, does not resolve with over-the-counter medications.
– Visual disturbances: Changes in vision like blurring of vision, flashing lights or spots.
– Nausea or vomiting: Persistent vomiting, upper abdominal pain after mid pregnancy.
Alarming symptoms:
– Severe hypertension: Systolic BP ≥ 160 mmHg or diastolic BP ≥ 110 mmHg.
– Thrombocytopenia: Platelet count less than 100,000 cells/microliter.
– Impaired liver function: Elevated transaminases levels.
– Progressive renal insufficiency: Rising serum creatinine greater than1.1 mg/dL or doubling of baseline.
– Pulmonary edema: Shortness of breath, hypoxemia, bilateral alveolar infiltrates on chest X-ray.
– Seizures: Not related to any other medical conditions like epilepsy.
– Intrauterine growth restriction: Estimated fetal weight <5th percentile for gestational age.
In conclusion, preeclampsia is a multisystem hypertensive disorder in pregnancy that requires close maternal and fetal monitoring to optimize outcomes. Early diagnosis and management of preeclampsia using antihypertensive medications, magnesium sulfate and delivery of baby at the appropriate time are essential to avoiding serious complications.
