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Female Reproductive System

Pre-eclampsia-Eclampsia Syndrome (PES)

Multisystem disorder of unknown aetiology characterised by the new-onset hypertension (≥140/90 mm-Hg) + proteinuria after the 20th week of pregnancy.

Preeclampsia is classically defined as the new onset of hypertension and proteinuria after 20 weeks of gestation. | Preeclampsia: Pathophysiology: Jorge Muniz, PA-C

Multisystem disorder of unknown aetiology characterised by the new-onset hypertension (≥ 140/90 mm-Hg) + proteinuria after the 20th week of pregnancy.

Hypertension + Proteinuria/end-organ damage

  • Features may appear before 20 in the case of:
    • Hydatiform mole
    • Acute polyhydramnios

Etiopathology

↑ Weight → Oedema ± HTN → Proteinuria

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Characterized by poor placental perfusion and a general disease process which may affect multiple organ systems.

Experiment supporting the concept that hypertension in pregnancy represents a uteroplacental response to ischemia
Experiment supporting the concept that hypertension in pregnancy represents a uteroplacental response to ischemia: a | In the Goldblatt model of renovascular hypertension, clamping the renal artery leads to development of hypertension through renal ischaemia in nonpregnant animals. b | By contrast, clamping the aorta below the renal arteries does not induce hypertension in nonpregnant animals. c | Aortic clamping in pregnant animals leads to hypertension. d | After hysterectomy, however, hypertension can no longer be elicited by aortic clamping, suggesting that the ischaemic pregnant uterus is the source of signals that lead to maternal systemic hypertension. Permission obtained from Semin. Perinatol. 12, Romero, R. et al. Toxemia: new concepts in an old disease, 302–323 © Elsevier (1988)
Placenta in preeclampsia
Here we see the interface between the fetal placenta and the maternal uterus (decidua and myometrium). In placental development, fetal cytotrophoblasts change from an epithelial phenotype to an endothelial phenotype as they invade maternal spiral arteries causing an increase in the vessels’ capacity which leads to healthy placental perfusion. In preeclampsia, the cytotrophoblasts fail to change phenotype. The result is a shallow invasion of the spiral arteries and, therefore, incomplete placental perfusion. © UpToDate Inc

Effects on mother:

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Effects on foetus:

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Diagnosis

Diagnostic criteria:

  1. Hypertension
  2. Oedema
    • Pitting oedema over tha ankles after 12 hours bed rest or rapid gain in weight of more than 1 pound
  3. Proteinuria
    • Presence of total protein in 24-hours urine of more than 0.3g or more than or equal to 2+ (1.0g/l) on at least 2 random clean-catch urine samples tested more than or equal to 4 hours apart in the absence of UTI

Lab investigations:

Laboratory values commonly used in pre-eclampsia
Shorthand for laboratory values commonly used in pre-eclampsia. LDH=Lactate dehydrogenase, Uric acid=Uric acid, AST=Aspartate aminotransferase, ALT=Alanine aminotransferase, Plt=Platelets, Cr=Creatinine.

Umbilical artery doppler:

Summary:

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