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Objectives
After completing this article, readers should be able to:
Describe the risk factors for and prevalence of preeclampsia.
Delineate the signs and symptoms and diagnostic criteria of preeclampsia.
Describe the basic management of preeclampsia, including decisions to deliver and the impact on the neonate.
Distinguish among hypertensive disorders of pregnancy.
Introduction
Preeclampsia is a disease unique to pregnancy, characterized by hypertension and proteinuria. Seen in 5% to 8% of all pregnancies, preeclampsia and hypertensive disorders of pregnancy are major causes of maternal, fetal, and neonatal morbidity worldwide. Hypertension is a sign of preeclampsia, and both conditions may create morbidity. The disease may be mild and inconsequential or cause death or significant maternal morbidity from stroke, seizures, cerebral edema, pulmonary edema, hepatic failure, renal failure, disseminated intravascular coagulation, or placental abruption. Fetal and neonatal consequences include intrauterine growth restriction (IUGR), stillbirth, and severe prematurity due to delivery for maternal indications.
The cause of preeclampsia is unknown. It is a multisystem disorder characterized by vasospasm and coagulation abnormalities. The only known treatment is delivery, after which the symptoms generally resolve. Without an alternative treatment, preeclampsia remains a major cause of iatrogenic prematurity.
This review addresses clinical aspects of hypertensive disorders of pregnancy, primarily preeclampsia, including prevalence, risk factors, cause, type, management, neonatal impact, and recurrence as well as areas of research, including preeclampsia prediction and prevention.
Epidemiology
Preeclampsia complicates between 5% and 8% of United States pregnancies and 3% to 14% of pregnancies worldwide. Hypertensive diseases of pregnancy are the second most frequent cause of maternal death in the United States, after embolism, and account for nearly 18% of deaths.
Most cases of preeclampsia are mild, and 90% occur after 34 weeks’ gestation. Earlier cases of preeclampsia tend to be more severe, although severe disease may develop at term. The disease usually occurs after …
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