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Pre-eclampsia is a multi-system disorder specific to pregnancy, characterized by the new onset of high blood pressure and often a significant amount of protein in the urine or by the new onset of high blood pressure along with significant end-organ damage, with or without the proteinuria.
Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. [1] Pre-eclampsia is a hypertensive disorder of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in the urine or other organ dysfunction, and edema.
This diagnosis can be made even if the patient does not have proteinuria. Women with preeclampsia with severe features are encouraged to deliver the child after 34 weeks of gestation to minimize the risks of the severe complications. [13] Preeclampsia can also present with seizures in the pregnant mother. [14]
Potential severe hypertensive states of pregnancy are mainly: Pre-eclampsia – gestational hypertension, proteinuria (>300 mg), and edema. Severe pre-eclampsia involves a BP over 160/110 (with additional signs). It affects 5–8% of pregnancies. [20] Eclampsia – seizures in a pre-eclamptic patient, affect around 1.4% of pregnancies. [21]
A high-risk pregnancy is a pregnancy where the mother or the fetus has an increased risk of adverse outcomes compared to uncomplicated pregnancies. No concrete guidelines currently exist for distinguishing “high-risk” pregnancies from “low-risk” pregnancies; however, there are certain studied conditions that have been shown to put the mother or fetus at a higher risk of poor outcomes. [1]
Drug treatment options are limited, as many antihypertensives may negatively affect the fetus. ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors are contraindicated in pregnancy as they are teratogenic. Methyldopa, hydralazine, nifedipine, and labetalol are most commonly used for severe pregnancy hypertension. [7]
The prognosis of this complication depends on whether treatment is received by the patient, on the quality of treatment, and on the severity of the abruption. Outcomes for the baby also depend on the gestational age. [5] In the Western world, maternal deaths due to placental abruption are rare.
Pregnant woman has severe pregnancy-induced hypertension, [49] severe eclampsia [49] /preeclampsia, [41] active vaginal bleeding, [49] placental abruption, a cardiac disease, [49] or another condition which indicates that the pregnancy should not continue. [49] Maternal hemodynamic instability with bleeding [41]