The Pathophysiology of Preeclampsia during Pregnancy - Essay Example

      Preeclampsia occurs more frequently in women less than 20 years of age and more than 35 years of age. Other risk factors include primigravida, hydatidiform mole, multiple pregnancies, urinary tract infection, black race, nulliparity, presence of chronic diseases like diabetes, obesity, chronic hypertension, and renal disease, and positive family history of preeclampsia (Erogul, Emedicine).

       Hypertension means a systolic blood pressure (BP) greater than 140 mm Hg and a diastolic BP greater than 90 mm Hg on 2 successive measurements 4-6 hours apart. Proteinuria means 300 mg or more of protein in a 24-hour urine sample or a urine protein-to-creatinine ratio of 0.19 or greater (Erogul, Emedicine).

      The pathophysiology of preeclampsia is not well established. However, most researchers believe that placental hypoperfusion is the inciting event resulting in the abnormal formation of uteroplacental spiral arterioles. These arterioles are highly sensitive to vasoconstriction. Placental hypoperfusion causes the release of systemic vasoactive compounds which cause an exaggerated inflammatory response, vasoconstriction, endothelial damage, capillary leak, hypercoagulability, and platelet dysfunction (Erogul, Emedicine).

       Mild-to-moderate preeclampsia may be asymptomatic. Most of the cases are detected through routine prenatal testing. In fact, symptoms are mostly seen when end-organs are affected. Some of the symptoms which can be attributed to preeclampsia are headache, visual disturbances, dyspnea, malaise, and edema. Along with increased blood pressure, a physical examination may reveal altered mental status, decreased vision, papilledema, hyperreflexia, seizures, and focal neuro deficit (Erogul, Emedicine).

      Preeclampsia should be managed by controlling blood pressure with antihypertensive agents. The goal should be to maintain diastolic blood pressure between 90 and 100 mm Hg and systolic pressure between 140 and 155 mm Hg. In case the patient develops seizures, the patient should be admitted to emergency care and treated with intravenous magnesium sulfate and proper fluid and electrolytes. When on magnesium sulfate, magnesium levels, respiratory rate, reflexes, and urine output must be monitored to detect magnesium toxicity. Seizures refractory to magnesium sulfate therapy should be managed with benzodiazepines and/or phenytoin. Prophylactic treatment with magnesium sulfate is indicated for all patients with severe preeclampsia.

     Patients with mild preeclampsia should be induced after 37 weeks and those with severe preeclampsia should be induced after 34 weeks.