PATHOPHYSIOLOGY

BOOK BASED

Pre eclampsia is a disorder that only happens in pregnant women. It occurs after 20
weeks gestation, and in some cases develops up to 6 weeks after delivery.it causes
new onset hypertension and proteinuria ( protein in the urine, which is a marker of
kidney damage. And can also cause damage to other organ like the brain and liver.
There can be a wide range of symptoms for some women there may be no symptoms
or only mild ones, whereas for other, it can turn into a life- threatening. Illness. If the
women with pre eclampsia develop seizures, she is said to have eclampsia. Tends to
occur more often during a first pregnancy in pregnancies with multiple gestation for in
mother 35 years or older. RISK FACTORS (FIRST PREGNANCY, MULTIPLE
GESTATIONAL, MOTHER > 35 YEARS. HYPERTENSIVE, DIABETES, OBESITY and
FAMILY HISTORY. Development of an abnormal placenta normally, during pregnancy
the spiral arteries dilate to 5-10 times their normal size and develop into uteroplacental
arteries capable of delivering large quantities of blood to the developing fetus. In pre
eclampsia, these uteroplacental arteries become fibrous causing them to narrow, which
means less blood gets to the placenta. And poorly perfused placenta can lead to
intrauterine growth restriction and even fetal death in severe cases. The hypoperfused
placenta starts releasing pro-inflammatory proteins these then get into the mother’s
circulation and cause the fundathelial cells that line her blood vessels to become
dysfunctional. Endothelial cell dysfunction cause vasoconstriction (or narrowing of the
blood) and also affects the kideney in a way that makes them retain more salt, both of
which result in hypertension. When diagnosing pre- eclampsia, hypertension is defined
as a systolic blood pressure of 140mmHg or greater or diastolic pressure of 90mmHg or
greater. In severe pre eclampsia, systolic blood pressure can be 110mmHg or greater.
These extreme blood pressure can lead to a hemorrhagic stroke or placental abruption
in which the placenta detaches prematurely from the uterine wall. There can also be
local ares of vasospasm, in which means that less blood might reach ceratin parts of the
body. EXAMPLE: reduced blood flow to the kidneys, which are particularly susceptible,
can cause glomerular damage leading tp oliguria ( very little urine) and
proteinuria ,normally the glomeli of the kidney do a good job of preventing protein from
spilling into the urine, so proteinuria can be a sign of glomerular damage and is a
classic sign of pre eclampsia.

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Reduced blood flow in the retina can cause blurred vision, the sensation of
seeing flashing lights and the development of scotoma.Reduced blood flow to the liver
can cause severe liver injury and swelling which can cause an elevation in liver
enzymes and stretches out the capsule around the liver. Stretching of the liver capsule
typically causes right upper quadrant pain, or epigastric pain, which is one of the
cardinal symptoms of severe preeclampsia. Endothelial injury also leads to the
formation of lots of tiny thrombi in the microvasculature, a process that uses up massive
amounts of platelets. Having all of these tiny blood clots in the blood is a bit like having
dozens of boulders in the middle of a fast moving river. It becomes treacherous for red
blood cells to navigate through, and before long, they slam up against a clot and get
destroyed - a process called hemolysis. This also may cause HELLP syndrome, HELLP
syndrome develops in about 10 to 20% of women with severe preeclampsia or
eclampsia. Finally, endothelial injury increases vascular permeability, allowing water to
slip out of blood vessels between neighboring endothelial cells and get into the tissues.
Because there’s also a loss of protein from the blood due to the proteinuria, even more
fluid moves from the blood vessels into the tissues. This causes generalized edema
which is often seen in the legs, face and hands; pulmonary edema which can cause
cough and shortness of breath; and cerebral edema which can cause headache,
confusion, and seizures.

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