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Preeclampsia
Published in Charles Theisler, Adjuvant Medical Care, 2023
Preeclampsia is a complication of pregnancy characterized by hypertension and signs of kidney damage (edema, proteinuria) and liver damage (elevated liver enzymes). Pre-eclampsia and eclampsia are the most common causes of maternal death. Therefore, prevention as well as early diagnosis and management are imperative.1 Preeclampsia usually begins after 20 weeks of pregnancy and increases the risk of poor outcomes for both the mother and the baby. In severe preeclampsia, hypertension may be accompanied by hemolysis, elevated liver enzymes, and low platelets (HELLP). Complications of preeclampsia include seizures, fetal growth retardation, low birth weight, premature or stillbirth, and, for the mother, liver or renal compromise. Women who develop seizures are diagnosed as having eclampsia.1
Fetal Development and Maternal Diet
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Hypertension during pregnancy consists of gestational hypertension, preeclampsia, eclampsia, and pre-gestational hypertension. Pregnancy-induced hypertension is a new-onset hypertension typically identified after the 20th week of gestation. Women with chronic hypertension present prior to pregnancy are at an increased risk for development of preeclampsia. Preeclampsia is defined as elevated blood pressure (20–30 mmHg systolic increase and/or 10–15 mmHg diastolic pressure increase) observed on two separate occasions at least 6 hours apart accompanied by proteinuria and/or edema. Other associated maternal morbidities include elevated liver function tests, blurred vision, severe headache, altered consciousness, and pulmonary edema. Eclampsia is the worsening of preeclampsia leading to seizures. The only cure for eclampsia is delivery of the fetus and placenta.
Urinary Tract Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Patients may be seen every 2–4 weeks until 32 weeks’ gestation, after which they may need to be seen weekly because of the markedly increased risk for severe pre-eclampsia. Careful monitoring of blood pressure and proteinuria for early detection of hypertension and superimposed pre-eclampsia should be performed at every visit.
Determinants of low birth weight among newborns delivered in China: a prospective nested case-control study in a mother and infant cohort
Published in Journal of Obstetrics and Gynaecology, 2023
Zhuomin Huang, Quanfu Zhang, Litong Zhu, Haishan Xiang, Depeng Zhao, Jilong Yao
The present results show that hypertensive disorders may lead to the birth of LBW newborns, consistent with the results of other studies (Velentgas et al.1994, Liu et al.2021c). Reduction in utero-placental perfusion is the most typical pathophysiologic mechanism of LBW (Jung et al.2022). Hypertensive disorders are characterised by both endothelial dysfunction and reduced blood placental perfusion (Agrawal and Wenger 2020). It has generally been observed that women with chronic hypertension have a high risk of preeclampsia compared to those without hypertension (Bartsch et al.2016, Ogunwole et al.2021). Impaired uteroplacental perfusion results in foetal growth restriction due to reduced oxygen and nutrition transport to the embryo. Uteroplacental ischaemia via maternal syncytiotrophoblast stress may be the aetiology of preeclampsia (Jung et al.2022). More attention should be paid to the intrauterine growth of the foetus and the development of anomalies in mothers with hypertensive disorders or preeclampsia.
Emerging pharmacologic interventions for pre-eclampsia treatment
Published in Expert Opinion on Therapeutic Targets, 2022
Xiao Zhang, Yue Chen, Dongli Sun, Xiaojun Zhu, Xia Ying, Yao Yao, Weidong Fei, Caihong Zheng
Pre-eclampsia, a complication of pregnancy, is defined as the new onset of hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg) after 20 weeks of gestation, following one or more new-onset symptoms, such as proteinuria, maternal organ dysfunction (including renal, hepatic, hematologic, and neurological impairment), or placental dysfunction (e.g. fetal growth restriction [FGR]) [1]. Globally, pre-eclampsia is observed in 2–5% of pregnancies [1]. Despite medical advance, there has been little improvement in the morbidity rate of pre-eclampsia. Moreover, pre-eclampsia can result in severe maternal complications and adverse perinatal outcomes, such as stroke, liver rupture, eclampsia-related seizures, and iatrogenic premature delivery. Furthermore, premature neonates exhibit a higher risk of respiratory disease, necrotizing enterocolitis, intraventricular hemorrhage, neurodevelopmental impairments, and various chronic diseases throughout their lifespan. Worldwide, pre-eclampsia causes approximately 76,000 and 500,000 annual deaths among women and neonates respectively [1]. The high morbidity and mortality of this disease not only creates a serious psychological and emotional burden for families, but also adds a huge economic burden to society at large.
ST2 and galectin-3 as novel biomarkers for the prediction of future cardiovascular disease risk in preeclampsia
Published in Journal of Obstetrics and Gynaecology, 2022
Nil Atakul, Yıldız Atamer, Şahabettin Selek, Berna Kılıç, Fatmanur Koktasoglu
One of the limitations of this study is the absence of pre-pregnancy CVD risk factor assessments but since our study population was considerably young and healthy, we assume that the effect of prepregnancy CVD risk factors had minimal impact on our results. Women with early-onset pre-eclampsia may have more risk factors simply because the risk factors are different. However, this does not distract from our primary conclusion that early-onset PE differs in pathophysiological aspects in cardiovascular changes and thus the risk for future cardiac and/or vascular diseases. Another limitation of our study is the lack of prospective evaluation of PE patients in our study, long term follow-up of our patients with high Gal-3 and ST2 levels in the PE group for the cumulative incidence occurring in the first five years after delivery may give more accurate results to determine patients at high-risk for developing CVD and elucidate relationships.