Definition: new onset of hypertension (140/90) and proteinuria during pregnancy.
Pathogenesis: Basically there are three factors involved:
Oxidative stress: higher levels of lipid peroxide andthromboxane have been found on placentas of patients with preeeclampsia.
Abnormal trophoblast invasion: Shallow trophoblast invasion and narrow spiral arteries.
Endothelial cell dysfunction.Clinical presentation: headache, epigastric pain, hyperreflexia, dizziness, tinnitus, tachycardia, fever, diplopia, amaurosis, scotoma, blurred vision, nausea, vomiting, hematemesis, oliguria, anuria,hematuria, hemoglobinuria. These are some of the signs and symptoms that could be encountered.
Types of hypertensive disorders:
Chronic hypertension: Hypertension present before pregnancy ordiagnosed before the 20th week of gestation. Or could also be hypertension first diagnosed during pregnancy but that doesn’t resolve 12 weeks postpartum.
Preeclampsia-eclampsia: usually occurs after the20th week of gestation or earlier if associated with mole or hydrops. Proteinuria is defined as more than 0.3g/24 hours.
Preeclampsia superimposed on chronic hypertension: known hypertensive whodevelops proteinuria. When proteinuria has been longstanding then patients usually present with HEELP syndrome.
Gestational hypertension can be further classified as transient if it resolves by 12weeks postpartum or chronic if it does not resolves in this period of time
Diagnosis: BP higher than 140/90 plus proteinuria greater than 0.3g in 24 hours.
Prediction: no prediction test is known.Prevention: Calcium supplements have not shown any benefit. Aspirin showed a slightly reduction on incidence but is no used because reduction is not significant. Antioxidants showed a significantreduction but the trial involved few patients so further investigation is required.
Treatment: Only curative therapy is delivery.
Magnesium sulfate: is more effective than phenytoin in...
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