Second and third trimesters :
Preeclampsia and eclampsia: Preeclampsia affects up to 5% to 10% of pregnancies.
The disease is characterized by a triad of hypertension, proteinuria and peripheral edema.
Hypertension and proteinuria characteristically regress after delivery.
Eclampsia is characterized by seizures, coma and other signs of preeclampsia, including hypereflexia, funduscopic changes in severe cases, cerebral edema, hepatic infarction, acute renal failure, congestive heart failure and acute respiratory distress syndrome.
Pathophysiology:
An uteroplacental mismatch, whereby the demands of the fetal placenta exceeds the maternal circulatory supply leads to placenta hypoperfusion, local hypoxia, endothelial cell dysfunction, abnormal expression of inflammatory mediators, alteration of vasomotor tone and activation of the coagulation cascade.
Clinical manifestations:
Nausea, vomiting and epigastric pain etc.
Associated with elevated levels of LDH, alkaline phosphatase, AST, ALT and uric acid.
The level of uric acid is an excellent marker for assessing disease severity and progression.
Liver function tests are abnormal in 20% to 30% of patients with preeclampsia and may be attributed to vasoconstriction of the hepatic vascular bed.
Therapy and outcome:
Women who develop preeclampsia before 32 weeks of gestation are 22 fold more likely to die than women who develop the condition at term.
Approximately 80% of maternal deaths are attributed to central nervous system complications.
Hepatic complications, including sub-capsular hematoma and rupture, infarction and hepatic failure, account for the remaining causes of mortality.
Fetal and placental complications include abruptioplacenta, prematurity and IUGR.
Severe disseminated intravascular coagulation (DIC) is a rare complication in the absence of placenta abruption.
The only effective treatment for preeclampsia is delivery of the fetus and placenta.
If mild preeclampsia is evident in the third trimester, expectant management with intensive monitoring may enhance fetal lung maturity.
However, any sign of maternal or fetal deterioration requires emergent delivery.
If eclampsia develops, magnesium sulfate is a treatment of choice for seizure prophylaxis.
Preeclampsia and eclampsia: Preeclampsia affects up to 5% to 10% of pregnancies.
The disease is characterized by a triad of hypertension, proteinuria and peripheral edema.
Hypertension and proteinuria characteristically regress after delivery.
Eclampsia is characterized by seizures, coma and other signs of preeclampsia, including hypereflexia, funduscopic changes in severe cases, cerebral edema, hepatic infarction, acute renal failure, congestive heart failure and acute respiratory distress syndrome.
Pathophysiology:
An uteroplacental mismatch, whereby the demands of the fetal placenta exceeds the maternal circulatory supply leads to placenta hypoperfusion, local hypoxia, endothelial cell dysfunction, abnormal expression of inflammatory mediators, alteration of vasomotor tone and activation of the coagulation cascade.
Clinical manifestations:
Nausea, vomiting and epigastric pain etc.
Associated with elevated levels of LDH, alkaline phosphatase, AST, ALT and uric acid.
The level of uric acid is an excellent marker for assessing disease severity and progression.
Liver function tests are abnormal in 20% to 30% of patients with preeclampsia and may be attributed to vasoconstriction of the hepatic vascular bed.
Therapy and outcome:
Women who develop preeclampsia before 32 weeks of gestation are 22 fold more likely to die than women who develop the condition at term.
Approximately 80% of maternal deaths are attributed to central nervous system complications.
Hepatic complications, including sub-capsular hematoma and rupture, infarction and hepatic failure, account for the remaining causes of mortality.
Fetal and placental complications include abruptioplacenta, prematurity and IUGR.
Severe disseminated intravascular coagulation (DIC) is a rare complication in the absence of placenta abruption.
The only effective treatment for preeclampsia is delivery of the fetus and placenta.
If mild preeclampsia is evident in the third trimester, expectant management with intensive monitoring may enhance fetal lung maturity.
However, any sign of maternal or fetal deterioration requires emergent delivery.
If eclampsia develops, magnesium sulfate is a treatment of choice for seizure prophylaxis.
No comments:
Post a Comment