Severe pre-eclampsia.Tom Archer, MD, MBADirector, OB
AnesthesiaUCSD HillcrestMarch 28, 202H!pertension in
pre"nanc!#Pre-eclampsia $HB%, protein&ria, e'ema, a(ter 20
)ee*s e"a+#Gestational hypertension $HB% a(ter 20 )ee*s e"a, no
protein&ria+. Ol' term, -pre"nanc!-in'&ce'
h!pertension..#Chronic hypertension $HB% ante'atin"
pre"nanc!+.#Superimposed pre-eclampsia/ pre-eclampsia on top o(
chronic h!pertensionThree causes of death in pregnancy:0
%&lmonar! throm1oem1olism02 Hemorrha"e#3 Hypertensie disorders
! pre-"Stro#eSei$ures%&C%re-eclampsia variants#2clampsia/
pre-eclampsia )ith sei3&res#H244% s!n'rome $hemol!sis, elevate'
liver en3!mes an' lo) platelets+Severe pre-eclampsia#SB% 5 60 or
DB% 5 0, 72, 6 ho&rs apart.#%rotein&ria 5 8 "m 9 2:
ho&rs $Hence 2:-ho&r &rine collection+#Oli"&ria ;
800 m4 9 2: ho&rsSevere pre-eclampsia#Cere1ral or vis&al
'ist&r1ances, HA, 1l&rre' vision or altere'
conscio&sness.#%&lmonar! e'ema $or lo) Sp02+.#2pi"astric or
C/ (ort&natel! rare.#Throm1oc!topenia#?etal "ro)th
restrictionTra'itional pre-eclampsia
tria',#H!pertension#%rotein&ria#2'ema@e) &n'erstan'in" o(
tra'itional pre-eclampsia tria',#H!pertension arteriolar
constriction $en'othelial '!s(&nction+.#%rotein&ria lea*!
"lomer&l&s $capillar!+ $en'othelial '!s(&nction+.#2'ema
lea*! capillaries in s*in, m&scle, liver, 1rain, air)a!, nose.
$en'othelial '!s(&nction+.-:th component. o( en'othelial
'!s(&nction in pre-eclampsia#M&sc&lar arter! spasm
increase' arterial )ave re(lection 1ac* to heart#>ncrease'
-a&"mentation in'eA. $A>A+#>ncrease' A>A eAtra )or*
(or heart m&scle#4BH, increase' B@% release CH?.Mo'ern concept
o( pre-eclampsia, s!mptoms are '&e to arterial, arteriolar an'
capillar!en'othelial 'ama"e.=, Dama"e 1! )hatCA, Chemical me'iators
(rom placenta-ToAemia o( pre"nanc!.#The ol'-(ashione' term is
act&all! ver! 'escriptiveD#The ischemic placenta "ives o((
toAins )hich 'ama"e the motherEs vasc&lar en'otheli&m
thro&"ho&t her
1o'!.))).si&me'.e'&9F'*in"29er"9ima"es9placenta.Gp"Sa!
-OUCHD.%re-2me'iatorsPoor placentation%re-eclampsia, ischemic
chorionic villi release pre-2 me'iators into maternal 1loo'.%re-2,
en'othelial 'ama"e#Deran"e' smooth m&scle (&nction, '&e
to'ama"e' en'otheli&m overl!in" smooth m&scle.#4ea*!
capillar! en'otheli&m $no smooth m&scle+. asodilatory
signals '()* prostacyclin+asoconstrictie signals 'throm,o-ane*
endothelin+2n'othelial cells sen' molec&lar si"nals to
s&rro&n'in" smooth m&scle.essel lumen&nsulin ma#es
endothelium producePre-eclampsia mediators 'and glucose+ ma#e
endothelium produceArcher T4 2006 &np&1lishe', >'ea (rom
Dan'ona % 200:"ndothelial factors in pre-":#>n health, there is
a 1alance 1et)een/vaso'ilator! (actors, @O, %H>2 $%rostac!clin+
an'/vasoconstrictive (actors, throm1oAane, en'othelin. #This normal
1alance is messe' &p in pre-2.O1esit!, h!per"l!cemia, sepsis
an' pre-eclampsia all -activate. $'ama"e+ en'otheli&m, )hite
cells an' platelets, lea'in" to )hite cell a'hesion an'
in(iltration, throm1osis an' e'ema $in(lammation+.O1esit!,
h!per"l!cemia, sepsis or pre-eclampsiaIBC%latelet%rotein
$e'ema+IBC%lateletsArcher T4 2006 &np&1lishe'Capillar!
en'otheli&m $no &n'erl!in" smooth m&scle+2n'othelial
'ama"e ca&ses pro1lems in J si3es o( 1loo'
vessels,#M&sc&lar arteries increase' )ave re(lection $heart
)or*, a&"mentation in'eA+.#Arterioles increase' SB
