pre-eclampsia

Pre-eclampsia is a disorder of pregnancy involving new-onset hypertension (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) and involvement of one or more other organ systems.

Epidemiology

Pre-eclampsia affects up to 8% of pregnancies .

Risk factors
  • diabetes mellitus
  • chronic hypertension
  • family history
  • nulliparity
  • advanced maternal age (>40 years) 
  • obesity

Clinical presentation

Pre-eclampsia involves new-onset hypertension after 20 weeks gestation in pregnancy and up to 4-6 weeks postpartum with one or more of:

  • proteinuria
  • thrombocytopenia
  • renal impairment (doubling of serum creatinine)
  • liver impairment (doubling of hepatic transaminases)
  • pulmonary edema
  • headache or visual disturbance

The addition of tonic-clonic seizures is known as eclampsia.

Pathology

The exact etiology of pre-eclampsia is still not fully understood. Although central to its development is believed to be the defective development of spiral placental arteries and subsequent placental ischemia.

Radiographic features

Ultrasound

Antenatal ultrasound may show intrauterine growth restriction due to placental insufficiency.

  • mean uterine artery PI may be above 95 percentile
CT

Cerebral edema and intracerebral bleeding have been reported in pre-eclamptic patients. The parieto-occipital region is the most frequently involved .

Treatment and prognosis

The only cure for pre-eclampsia is delivery of the fetus. Pre-eclampsia is a major source of maternal and fetal morbidity and mortality .