Ob-Gyn Clerkship: Week 6 Assignment

Pre-eclampsia

Cause of the condition

Pre-eclampsia is a disorder exclusively in pregnancy and occurs only in a 4-7% of women. This
condition it’s a new onset hypertension with proteinuria or end-organ dysfunction after 20 weeks
of gestation. Women should have high risk if have any other condition such as preexisting
hypertension, diabetes, chronic kidney disease or autoimmune disorders. Pre-eclampsia its cause
by abnormal placental spiral arteries that lead to a endothelial dysfunction, vasoconstriction and
ischemia.

Common sign, symptoms, and presentation

Symptoms for women with pre-eclampsia should be elevated blood pressure and proteinuria.
Women can present edema in hand, ankle and facial. If the case is severe the patient can present
severe hypertension >160/110, headache, visual disturbance, epigastric pain or right upper
quadrant pain, proteinuria and oliguria and altered mental status. (1)

Pathophysiology
This pathophysiology is not completely understood but some research can demonstrate that its
cause by inappropriate trophoblast differentiation during the endothelial invasion expected by
abnormal regulation and production of cytokines, adhesion molecules, major histocompatibility
complex molecule and metalloproteinases are the major keys in the development of high blood
pressure in pregnancy. The abnormal regulation for those molecule lead to abnormal
development and remodeling of spiral arteries that lead to a placenta hypoperfusion and
ischemia. (1)

Diagnostic criteria and tests

Diagnostic criteria for pre-eclampsia should be blood pressure management at least 2 times in 4
hours apart. Urine test such 24 hours urine collections it’s a gold standard por proteinuria and the
result should be >300mg/24 hours, urine dipstick > 1+ proteins and urine protein/creatinine ratio
>0.3mg/dl. Laboratory analysis such as complete blood count, liver and kidney function test and
coagulopathy tests. (2)

Treatments options
Initial evaluation it’s a fetal ultrasound, nonstress test and biophysical profiling if nonstress is
nonreactive. In many cases can be outpatient monitoring such as maternal monitoring 1-2 times
in week, fetal monitoring(ultrasound) every 3 weeks and antihypertensive drug for severe
hypertension such as hydralazine, labetalol, methyldopa and nifedipine. The ACE inhibitor and
ARB are contraindicated during pregnancy for their teratogenic effects. In severe cases the only
cure it’s a delivery, and then a daily maternal monitoring and daily fetal nonstress test. The
mother can be management with magnesium sulfate for prophylaxis of eclampsia. (2)

Prognosis
Majority of this cases can be resolves within hours or days after delivery. Any patients can
develop eclampsia that the patient have same symptoms for pre-eclampsia with seizures.

References
1. Luger R, Kight B. Hypertension In Pregnancy. Ncbi.nlm.nih.gov.
https://www.ncbi.nlm.nih.gov/books/NBK430839/. Published 2021. Accessed February
12, 2021.
2. Pre-eclampsia | Clinical Genomics: Practical Applications in Adult Patient Care |
AccessMedicine | McGraw-Hill Medical. Accessmedicine.mhmedical.com.
https://accessmedicine.mhmedical.com/content.aspx?
sectionid=61904661&bookid=1094&Resultclick=2#1102703838. Published 2021.
Accessed February 12, 2021.