Preeclampsia is a first onset of hypertension and proteinuria after 20 weeks. Eclampsia is the unexplained occurrence of generalized seizures in pre-existing pre-eclampsia. The diagnosis is made by clinical findings and the determination of protein in the urine. Treatment usually consists of the administration of magnesium sulphate and birth at term.

Preeclampsia affects 3-7% of pregnant women. Pre-eclampsia and eclampsia develop after 20 weeks; up to 25% of cases they do not develop until the postpartum period, usually in the first 4 days, but sometimes up to 6 weeks after birth.

Preeclampsia is a first onset of hypertension and proteinuria after 20 weeks. Eclampsia is the unexplained occurrence of generalized seizures in pre-existing pre-eclampsia. The diagnosis is made by clinical findings and the determination of protein in the urine. Treatment usually consists of the administration of magnesium sulphate and birth at term. Preeclampsia affects 3-7% of pregnant women. Pre-eclampsia and eclampsia develop after 20 weeks; up to 25% of cases they do not develop until the postpartum period, usually in the first 4 days, but sometimes up to 6 weeks after birth. An untreated preeclampsia like for an indefinite period, smolder up from it all of a sudden, to himself as happens in 1/200 cases of preeclampsia, created eclampsia. An untreated eclampsia usually fatal. Etiology The etiology is unknown; However, there are the following risk factors: Nulliparity already existing chronic hypertension vascular disease (. eg kidney disease, diabetic vasculopathy) Already existing diabetes or gestational diabetes Elderly (> 35 years) or very young (. eg <17 years) Mother preeclampsia Family history preeclampsia or poor history of previous pregnancies multiple pregnancy obesity thrombotic disorders (eg., anti-Phospholipidantikörper syndrome, antiphospholipid antibody syndrome (APS)) pathophysiology The pathophysiology of preeclampsia and eclampsia will be insufficient. Important factors could (which the uteroplacental blood flow during late pregnancy, reduce) its puny developed spiral arteries of the placenta, a genetic abnormality on chromosome 13, immunological abnormalities or ischemia or infarction of the placenta. A peroxidation of cell membrane lipids, which is triggered by free radicals could contribute to preeclampsia. Complications Fetal retardation or death may result. General diffuse or focal vasospasm can affect and ischemia in the mother some organs, especially the brain, kidney and liver damage. Among the factors that may cause the vasospasm, including a decreased prostacyclin (a endothelial vasodilator), increased endothelin (a vasoconstrictor endothelial) and an increased soluble Flt-1 (a circulating receptor for vascular endothelial growth factor [VEGF]). Women with preeclampsia have a risk of placental abruption in the current and future pregnancies, possibly because both disorders associated with uteroplacental insufficiency are. Probably secondary to a malfunction of endothelial cells leads to activation of platelets, the coagulation system is activated. The HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count) develops in 10-20% of women with severe pre-eclampsia or eclampsia; This incidence is about 100-fold increased compared to the total number of pregnancies (1-2 / 1000). Most, but not all pregnant women with this syndrome have hypertension and proteinuria. Symptoms and complaints Pre-eclampsia may be asymptomatic or cause edema and massive cause weight gain. Edema in the non-dependent parts such as swelling of the face or hands (the ring finger of the patient does not fit), are more specific than edema in the dependent parts. Increased Reflexreaktivität may occur, which indicates a neuromuscular irritability and possibly seizures developed (eclampsia). Petechiae can develop like other signs of coagulopathy. Tips and risks should be taken to swelling in your hands (eg. As a not matching ring) or on the face and hyperreflexia, which may belong to the more specific findings in preeclampsia. A pronounced pre-eclampsia can cause organ damage, in headaches, blurred vision, confusion, epigastric pain or right upper quadrant ((as a sign of hepatic ischemia or stress the joint capsule), nausea, vomiting, shortness of breath caused by pulmonary edema, acute respiratory distress syndrome or cardiac failure as manifest result of increased afterload), stroke (rare) and oliguria (indicating a reduced plasma volume or acute ischemic tubular necrosis of the kidneys). Emerging diagnostic hypertension (blood pressure> 140/90 mmHg) and new unexplained proteinuria> 300 mg / 24 hours after the 20th week of pregnancy. The suspected diagnosis is made on the basis of symptoms or a possible hypertension, defined as systolic blood pressure> 140 mmHg and / or diastolic blood pressure> 90 mmHg. Except in emergencies hypertension should be detected in> 2 measurements at a distance of at least 4 hours. The protein excretion in the urine is determined over a 24-h urine collection. defined as 24 hours proteinuria> 300 mg /. Alternatively, the proteinuria on the basis of protein: creatinine ratio (used only if other quantitative methods are not available) ? 0.3 or a dipstick measurement of 1+ diagnosed. Is based on less accurate tests (eg., Urine sticks, routine urine examination) found no proteinuria, pre-eclampsia can not be excluded. In the absence of proteinuria, pre-eclampsia is also diagnosed when pregnant women new onset hypertension and new onset of any of the following are: thrombocytopenia (platelet count <100,000 / ul) renal insufficiency (serum creatinine> 1.1 mg / dL or doubling of serum creatinine gt in women without kidney disease) hepatic impairment (aminotransferases? 2 times normal) pulmonary edema cerebral or visual symptoms the following criteria are helpful in differentiating hypertensive disorders in pregnancy: a chronic hypertension is when a hypertension of pregnancy precedes already in of <20 weeks is present or for> 6 weeks (usually> 12 weeks) remains postpartum (even if the hypertension was first documented in the> 20 weeks). A chronic hypertension can be masked by the physiological decrease in blood pressure during early pregnancy. A pregnancy-related hypertension is hypertension without proteinuria or other findings of preeclampsia; she first enters> 20 weeks in women without known hypertension before pregnancy and disappears 12 weeks (usually 6 weeks) after birth. Pre-eclampsia is a new-onset hypertension (blood pressure> 140/90 mmHg) and new unexplained proteinuria (> 300 mg / 24 hours) after 20 weeks, or other criteria (s. O.). A superimposed by chronic hypertension Preeclampsia is diagnosed when a new unexplained proteinuria after 20 weeks in a woman developed that already had hypertension, or if the blood pressure increases or signs of severe pre-eclampsia after 20 weeks at a Ms. develop that already has high blood pressure and proteinuria. Further clarification to the laboratory tests required for a diagnosis of pre-eclampsia include a urinalysis, a complete blood count, uric acid, liver function tests and determination of serum electrolytes, blood urea nitrogen, creatinine and creatine clearance. The fetus is evaluated using a Nonstress-test or a biophysical profile (including evaluation of amniotic fluid volume) and tests for the assessment of fetal weight. HELLP syndrome is suspected by microangiopathic findings (z. B. schistocytes, fragmentocytes) in a peripheral blood smear elevated liver enzymes, and low platelet count. Severe preeclampsia is distinguished from a light by one or more of the following criteria: CNS disorder (. Eg blurred vision, scotoma, clouding of consciousness, severe headache that is not better with acetaminophen) symptoms of stress the liver capsule (eg. . pain in the right upper quadrant or epigastric) nausea and vomiting AST or ALT serum levels> 2-fold above normal systolic blood pressure> 160 mmHg or diastolic blood pressure> 110 mmHg at 2 measured at a distance ? 4 hours platelet count <100,000 / ul urine output <500 ml / 24 h pulmonary edema or cyanosis stroke Progressive renal insufficiency (serum creatinine> 1.1 mg / dL or doubling of serum creatinine in women without kidney disease) Behan Usually dlung hospitalization and occasionally antihypertensive treatment delivery, depending on factors such as gestational age, detection of fetal maturity and severity of pre-eclampsia magnesium sulfate for the prevention or treatment of seizures Basic Procedure The ultimate therapy is the delivery. However, the risk of premature birth to the gestational age, the threat of pre-eclampsia and responding to other treatments must be weighed. In general, the immediate delivery after stabilization of the mother (. Eg seizure control, starting control of blood pressure) is indicated in the following cases: Pregnancy in ? 37 weeks eclampsia Severe pre-eclampsia in the ? 34 weeks or evidence of fetal lung maturity deterioration of kidney, lung, heart or liver function No improvement in the fealen monitoring or testing other therapies have the goal of doing the best for the mother’s health, which is usually the best for the fetus. When the delivery can be delayed approximately between the 32th and 34th week of pregnancy corticosteroids for 48 hours, to accelerate fetal lung maturity be given. Most patients are hospitalized. Patients with eclampsia or severe preeclampsia often come to a special ward for mothers or Intensivstation.Leichte preeclampsia With only slightly more pronounced preeclampsia therapy can be performed on an outpatient basis. This includes strict bed rest, the left lateral position, whenever possible, and blood pressure measurements, monitoring laboratory values ??and doctor visits 2 to 3 times / week. However, in most patients a hospital stay is with mild preeclampsia, at least initially, is required; Some also need medical treatment for several hours to stabilize it and reduce the systolic blood pressure of 140-155 mmHg and diastolic blood pressure 90 to 105 mmHg. Hypertension can be treated with oral medicines as needed. Pending criteria for severe pre-eclampsia are true, the confinement (eg., By introduction) in the 37 weeks erfolgen.Überwachung Ambulatory patients can usually once every 2 or 3 days for signs of convulsions, symptoms of severe pre-eclampsia and examined vaginal bleeding; Blood pressure, reflexes and status of the fetal cardiovascular system (using a Nonstress-test or a biophysical profile) should also be controlled. Platelet count, serum creatinine and serum liver enzymes are often intended to stabilize, then measured at least once a week. All stationary patients are managed by an obstetrician or a specialist for prenatal and tested as ambulatory patients (as described above); an investigation is carried out in severe pre-eclampsia or pregnancy <34 weeks häufiger.Mg sulfate Once eclampsia or severe preeclampsia is diagnosed, Mg sulfate must be given to stop seizures or prevent and reduce the increased reflex readiness. Whether patients will always need a slight pre-eclampsia before birth Mg sulfate, is controversial. Following administration of magnesium sulfate 4 g iv over 20 minutes followed by a continuous infusion of 1-3 g / h and additional doses as needed. Based on reflex status of the patient, the dose is adjusted. Patients with massive increase in Mg levels (e.g., as with a Mg levels> 10 mEq / l or a sudden decrease in the Reflexreaktivität), cardiac disorders (eg. For example, with shortness of breath or chest pain) or hypoventilation after treatment with magnesium sulfate with Ca-gluconate 1 g iv treated. Mg sulfate can lead to apathy, hypotension, and transient respiratory depression of the newborn. Nevertheless, serious neonatal complications selten.Unterstützende treatments are Inpatients receive Ringer’s lactate solution or 0.9% saline solution i.v. starting at a dose of 125 ml / h (to increase the urinary excretion). A persistent oliguria is treated with a carefully controlled, increased fluid load. Diuretics are not usually given. Monitoring with a pulmonary artery catheter is rarely necessary and, if necessary, is carried out in consultation with a specialist and critical care in an intensive care unit. Normovolaemic, anuric patients need substances to enhance the renal perfusion or dialysis in some cases. If the cramps occur despite Mg therapy, diazepam or lorazepam can i.v. are added to interrupt the seizures. To lower systolic blood pressure to 140 to 155 and diastolic blood pressure to 90 to 105 mmHg you are hydralazine or labetalol iv in titrated Dosis.Geburtsmodus The most suitable mode of delivery should be applied. If the cervix is ??favorable and a vaginal delivery appears feasible, an oxytocin infusion should be given to speed up the birth; with good labor, the amniotic sac is then blown up. If the findings of the cervix immature and a rapid vaginal delivery rather unlikely, given birth by caesarean section may be considered. Although pre-eclampsia and eclampsia were not completely dominated before birth, so they sound then usually quickly, often within 6 to 12 hours. All patients typically receive after birth Mg sulphate 24 Stunden.Kontrolluntersuchung In postpartum blood pressure of these patients should be regularly monitored every 1-2 weeks. Carry 6 weeks after birth continue to elevated blood pressure, patients may have a chronic hypertension and should be referred to their GP for treatment. Summary Preeclampsia develops after the 20th week; she steps on postpartum in 25% of cases. Swelling of the face or hands and hyperreflexia are relatively specific findings for preeclampsia. There is a severe preeclampsia when significant organ disorders (demonstrated clinical evidence, or tests) gives. HELLP syndrome occurs in 10-20% of women with severe pre-eclampsia or eclampsia. Mother and fetus should be closely, usually monitored in a hospital or an intensive care unit. Once a severe pre-eclampsia or eclampsia is diagnosed, is treated with high Mg sulfate doses; in mild preeclampsia, administration of magnesium sulfate is less certain. A delivery is usually displayed from the 37th week of pregnancy in case of serious problems or fetal lung maturity.

Health Life Media Team

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