1. PREECLEMPSIA & ECLEMPSIA

2. OUTLINE INTRODUCTION PATHOPHYSIOLOGY EPIDEMIOLOGY SIGNS & SYMPTOMS
RISK FACTORS
INVESTIGATION
MANAGEMENT &/TREATMENT
COMPLICATIONS
CONCLUSION
REFERENCES

3. INTRODUCTION
Pre(eclampsia) is one of the hypertensive disorders of pregnancy;
Chronic hypertension (with superimposed preeclampsia)
Gestational hypertension
Preeclampsia-eclampsia(post partum)
Preeclampsia a rapid rise in arterial blood pressure to hypertensive levels associated with proteinuria
Eclampsia represents the consequence of brain injuries caused by pre-eclampsia e.g convulsions
Hypertensive disorders of pregnancy
Chronic hypertension; hypertension before the 20 weeks of pregnancy
Chronic hypertension with superimposed preeclampsia; before week 20 and persists to post partum
Gestational hypertension; diagnosed from week 20 onwards
Preeclampsia; gestational hypertension associated with clinical features e.g proteinuria
Eclampsia; Abrupt development of seizures or coma during the gestational period or post-partum, non-attributable to other neurologic diseases

5. PATHOPHYSIOLOGY
The pathophysiology of pre-eclampsia is still uncertain eventhough, some theories exist that try to explain it;
Abnormal plancentation, placenta ischemia and oxidative stress results to maternal endothelial dysfunction responsible for the clinical presentations.
NB/:Decidual natural killer cells regulate trophoblast invasion and vascular growth
Genetic theory, existence of suspectibility genes for preeclampsia activated via metabolic interactions (angiotensinogen)
Immunological theory, apoptosis of the extravillous cytotrophoblast by an overexpressed maternal immunity system
An abnormal expression of NK cell surface antigens and a failure in the regulation of NK cell cytotoxicity and cytokines or angiogenic factors may be some of the causes of pre-eclampsia

7. EPIDEMIOLOGY
Preeclampsia is the second leading cause of maternal death, affects 3-4% of all pregnant women. All together 10% of pregnant women are affected by a hypertensive complication of pregnancy.
Pre-eclampsia predominantly affects women in their first pregnancy (2-8% of first pregnancies)
The incidence of preeclampsia ranging from 1.8 to 16.7% was estimated to be seven times higher in developing countries than in developed countries
In Tanzania, eclampsia is associated with 11% case fatality rate and 30% mortality rate (Mooij et al., 2015).

8. SYSTEMS SIGNS/SYMPTOMS CENTRAL NERVOUS Headaches Visual disturbances
Seizures
RENAL SYSTEM
Proteinuria
Oliguria
Abnormal kidney tests
Hypertension
CARDIORESPIRATORY SYSTEM
Chest pain
Dyspnea
Low oxygen saturation
Pulmonary edema
HEMATOLOGIC SYSTEM
Intravascular disseminated coagulation
Hemorrhage
Coagulation impairment
Shock
VASCULAR SYSTEM
Severe hypertension
HEPATIC SYSTEM
Abnormal liver function
Epigastric pain
Nausea

9. RISK FACTORS History of pre eclampsia(family,previous)
Diabetes mellitus (type I or II)
Multiple pregnancy
First pregnancy
Overweight(BMI ≥ 35 Kg/m2)
Maternal age (40 years old)
Chronic autoimmune disease
Intergestational interval ≥10 years

10. INVESTIGATIONS
Hypertension (>140/90 mm Hg) and onset proteinuria (≥1+ proteinuria on reagent stick testing)
Full blood count—To look for platelet consumption owing to haemoconcentration
Urea and electrolytes—To look for renal dysfunction
Liver enzymes—To look for transaminitis HELLP(Hemolysis Elevated Liver enzymes and Low Platelets) syndrome
Urinalysis—To quantify clinically significant proteinuria
Assessment of fetus—Ultrasound for fetal growth and the volume of amniotic fluid; and Doppler velocimetry of umbilical arteries.

11. MANAGEMENT & TREATMENT
Low aspirin dosage (prevention)
Corticosteroid therapy (dexamethasone,betamethasone) for pulmonary maturation
Antihypertensive medication (nifedipine, labetolol, or methyldopa) to lower blood pressure
Magnesium sulfate (MgSO4) for the treatment of eclamptic convulsions
TREATMENT
Delivery at (34-37weeks) expectant management is provided for fetal maturity.

12. COMPLICATIONS Premature birth Fetal growth restriction Fetal death
Psychosis
Renal failure
CNS damage
Intracranial hemorrhage
HELLP syndrome(Hemolysis Elevated Liver enzymes and Low Platelets)

14. DID YOU KNOW? Smoking protects pregnant women from developing pre-eclampsia. ???
ANSWER
Smoking enhances the expression of ligands of the vascular endothelial growth factor (VEGF) family, which regulate the differentiation and survival of cytotrophoblasts, leading to normal uterine invasion
!!!!!!Nonetheless, it is still not recommended that pregnant women smoke, since smoking is a risk factor for several complications during pregnancy, namely;
Miscarriages,
Placental abruption,
Preterm delivery,
Reduced birth weight

15. REFERENCES
Nirupama R, Divyashree S, Janhavi P, Muthukumar SP, Ravindra PV. Preeclampsia: Pathophysiology and management. J Gynecol Obstet Hum Reprod Feb;50(2): doi: /j.jogoh Epub Nov 7. PMID:
Jennifer & Carbonnel, Marie & Piconne, Olivier & Asmar, Roland & Ayoubi, Jean. (2011). Pre-eclampsia: Pathophysiology, diagnosis, and management. Vascular health and risk management /VHRM.S20181.ampsia_Pathophysiology_diagnosis_and_manage ment
Prevalence and risk factors for preeclampsia/eclampsia in Northern Tanzania
Peres, Goncalo M., Melissa Mariana, and Elisa Cairrao.2018.”Pre- eclampsia and Eclampsia: An update on the Pharmacological Treatment Applied in Portugal”Journal of Cardiovascular Development and Diseases 5