5 - 7%

True or False:

Hypertensive disorders are the second leading cause of maternal mortality.

BP > 140/90

and 

Proteinuria > 0.3 g in 24 hrs

in a woman normotensive prior to 20 weeks

Chronic HTN is BP > 140/90 before 20 weeks gestation

True or False:

Woman with chronic HTN are 2 - 3X more likely to develop preeclampsia

1. BP > 140/90 without proteinuria

2. Provisional diagnosis - confirmed postpartum

3. If elevation persists beyond 12 wks PP = chronic HTN

1. Edema - esp. periorbital, hands

2. BP change

3. Proteinuria

4. Retinal changes - copper wiring and AV nicking indicate chrnic HTN

5. Hyperreflexia

6. JVD, gallop, rales, DIC, thrombocytopenia

7. HA

Dizziness

Tinnitus

Diplopia

Scotoma

Blurred vision

Amaurosis

N/V

Epigastric pain

Hematemesis

Oliguria/anuria

Hematuria

1. Liver - hemorrhage then infarction (elevated LFT's)

2. Kidney - inc. size of glomerular endothelial cells, inc. fibrin deposition

3. Brain - vasospasm, cerebral edema

Decreased cardiac output

Increased sensitivity to angiotensin II

Increased angiotensinogen, renin, and aldosterone

Decreased GFR

Decreased sodium excretion

Activation of coagulation cascade

True or false:

There is NO genetic component involved in preeclampsia

FALSE

Preeclampsia is more likely among sisters.

If either parent was the result of a preeclmptic pregnancy = more likely to produce a preeclamptic pregnancy

True or False:

Use of barrier contraception and short length of cohabitation increase the risk of preeclampsia

TRUE

There is an immunologic component

1. Oxidative metabolites from baby are transferred to mom - superoxides damage cells

2. Lipid peroxides damage endothelium = atherosclerotic changes

3. Placentas in preeclamptic pregnancies are higher in lipid peroxides than normal pregnancies

1. Cells appear damaged in vitro

2. Damaged cells release fibronectin, VCAM-1, and other pepides

3. Damaged cells initiate coagulation

4. Platelet adhesion may occur

True or False:

ASA may be a possible treatment for preeclampsia

TRUE

Vessels in preeclamptic pt.'s produce less prostacyclin - if prostacyclin or ASA is given, the usual resistance to angiotensin is restored 

Placenta is often implanted shallowly

(r/t IUGR)

1. New blood vessel formation depends on VEGF

2. Preeclamptic placenta makes too much sFlt-1

3. sFlt-1 inactivates VEGF

4. sFlt-1 increases in maternal serum 5 weeks before onset of preeclampsia

True or False:

We have a multitude of clinically useful predictive tests for preeclampsia.

HTN

DM

Extremes of reproductive age

1st pregnancies

Mag. sulfate

140/90

Lower than this may compromise uteroplacental blood flow since the body is used to the higher pressures

1. Aldomet - for chronic tx (250 mg to 2 g per day)

2. Nifedipine - chronic tx (10 - 90 mg daily)

3. Labetalol - acute tx (20 mg, followed by 40 mg 10 min. later; up to 80  g IV)

4. Hydralazine - acute tx (5 mg IV over 10 min, may give an additional 5-10 mg 20 min. later)

True or false:

Patients can present with eclampsia postpartum

TRUE

* Up to 33% present intrapartum or up to 48 hrs PP

* About 15% present > 48 hrs PP

*Possibly in recurrent preeclamptics and multips with preeclampsia.

*One study showed that preterm preeclamptics may be at greater risk for ischemic heart disease.

*Newer studies are showing more links with preeclampsia and CV and renal disease later in life.