Association of Cameroonian Physicians in the Americas

    Preeclampsia: What is it (part 1)

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    Definition 

    Preeclampsia is a condition which can occur in pregnant women after 20 weeks of pregnancy. It consists of new onset persistent high blood pressure (systolic BP greater than 140 mmhg and/or diastolic BP greater than 90 mmHg) along with the presence of protein in the urine and other signs of damage to other organ systems. Essentially, think of your kidneys as a sieve (sifter), a properly functioning kidney should not all any large molecules (like proteins) to pass through and be excreted in the urine. So, in essence a healthy kidney should be a sieve (sifter) with very tiny holes to block all the protein and other molecules from passing through. In preeclampsia due to the effects of the high blood pressures in the kidney, you will have protein in your urine more than 0.3g/24 hours. So, in pre-eclampsia the holes of the sieve are bigger allowing protein to pass through. You can also see other signs of the kidney not working properly like elevations in creatinine (a sign that your kidney is not filtering properly). Other things like Liver injury (elevated liver enzymes), right upper abdomen pain, a decrease in the number of platelets in your blood and neurological complications like seizures and the poor growth of your baby can also be seen.


    Types of preeclampsia

    According to the American College of Obstetricians and Gynecologists (ACOG), preeclampsia can occur with or without severe features. Mild to moderate preeclampsia is diagnosed in women with blood pressures 140-159 mmHg/90-109 mmHg) who also have proteinuria of 300 mg/24 hours or more or a protein/creatinine ratio greater than 0.3 mg/dL.


    Severe preeclampsia is diagnosed by systolic blood pressure greater than 160 mmHg and/or diastolic blood pressure greater than 110 mmHg on at least 2 occasions taken at least 4hours apart while the patient is calm and resting and proteinuria (300 mg/ 24 hours) or a protein/creatinine ratio greater than 0.3 mg/dL. A SBP greater than 169 mmHg and/or a DBP greater than 110 mmHg (on 2 occasions at least 6 hours apart while calm and at rest) and without proteinuria with either low platelets or kidney damage or liver damage, fluid in your lungs (pulmonary edema) or difficulty seeing or problems with your brain.
    Other laboratory findings which can be seen in women with preeclampsia include Serum creatinine greater than 1.1 mg/L or a doubling of your normal serum creatinine by 2 without a prior history of kidney disease and liver injury as evidenced in liver enzymes increase by twice their normal levels. Pulmonary edema (fluid in the lungs causing trouble breathing) and headaches or trouble seeing can also be present.

    Signs and symptoms
    Symptoms that are seen in a woman who is over 20 weeks pregnant include high blood pressure, nausea, vomiting, headaches (that remain even after treatment), upper abdominal pain usually in the right, swelling (especially in the face, around the eyes and hands), trouble seeing (flashing lights, blurry vision, seeing spots), racing heartbeat, seizures, trouble urinating, difficulty breathing, difficulty urinating, hyperreflexia and or clonus (a twitching/jerking like movement). Your baby may also have reduced movement in the uterus and may be experiencing poor growth. In severe cases, women with preeclampsia may progress to having seizures or a cerebrovascular accident (stroke)

    How is preeclampsia diagnosed?
    Preeclampsia is diagnosed based on blood pressure assessment and evaluation of the urine for protein. Tests that can be done to diagnose preeclampsia include urinalysis (urine test to check for proteins), complete blood count, liver function tests, kidney function tests, blood clotting tests, fetal ultrasound, fetal biometry (to see if the fetus is growing), fetal cardiotocography (recording the fetal heartbeat and the uterine contractions), umbilical artery Doppler velocimetry (to see if the artery that supplies blood to the uterus is working properly) and amniotic fluid assessment.


    Author: Shirley Ayuk-Takem, DO

    Reviewer: Efua B. Leke MD, MPH

    References: American College of Obstetricians and Gynecologists (ACOG)

    Preeclampsia: What is it (part 2)
    Top 10 reasons why you should join ACPA
     

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