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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.
Pre-eclampsia affects up to 8% of pregnancies 1.
diabetes mellitus 2
chronic hypertension 2
family history 2
advanced maternal age (>40 years) 2
anti-phospholipid syndrome (nine-fold increased risk) 5
pre-eclampsia in prior pregnancy (seven-fold increased risk) 5
Pre-eclampsia involves new-onset hypertension after 20 weeks gestation in pregnancy and up to 4-6 weeks postpartum with one or more of:
renal impairment (doubling of serum creatinine)
liver impairment (doubling of hepatic transaminases)
headache or visual disturbance
The addition of tonic-clonic seizures is known as eclampsia.
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.
The mean uterine artery PI may be above the 95th percentile.
Spectral Doppler of the maternal internal carotid artery and distal anterior circulation vasculature may demonstrate:
an ophthalmic artery RI <0.72 has been suggested to correlate with a higher risk of maternal/fetal complications 10
transcranial Doppler sonography of the maternal middle cerebral artery (MCA) may demonstrate:
decreased pulsatility index (PI) and resistive index (RI)
these changes have also been noted to be predictive of the subsequent development of pre-eclampsia in normotensive patients during the second trimester 7,8
suggested cutoff values have been proposed, such as an MCA RI <0.54 and MCA PI <0.81 7
Treatment and prognosis
When severe features are present temporizing measures may include the administration of intravenous magnesium sulfate and use of select antihypertensive medications to carefully decrease the blood pressure. The definite management for pre-eclampsia is delivery of the fetus. Pre-eclampsia is a major source of maternal and fetal morbidity and mortality 4.
- 1. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. (2013) Obstetrics and gynecology. 122 (5): 1122-31. doi:10.1097/01.AOG.0000437382.03963.88 - Pubmed
- 2. ACOG technical bulletin. Hypertension in pregnancy. Number 219--January 1996 (replaces no. 91, February 1986). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists. (1996) International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 53 (2): 175-83. Pubmed
- 3. Gathiram P, Moodley J. Pre-eclampsia: its pathogenesis and pathophysiolgy. (2016) Cardiovascular journal of Africa. 27 (2): 71-8. doi:10.5830/CVJA-2016-009 - Pubmed
- 4. Chang WN, Lui CC, Chang JM. CT and MRI findings of eclampsia and their correlation with neurologic symptoms. (1996) Zhonghua yi xue za zhi = Chinese medical journal; Free China ed. 57 (3): 191-7. Pubmed
- 5. Khalil G, Hameed A. Preeclampsia: Pathophysiology and the Maternal-Fetal Risk. (2017) J Hypertens Manag 3:024. doi.org/10.23937/2474-3690/1510024 ClinMed
- 6. Ohno Y, Kawai M, Wakahara Y, Kitagawa T, Kakihara M, Arii Y. Transcranial Assessment of Maternal Cerebral Blood Flow Velocity in Patients with Pre-Eclampsia. Acta Obstet Gynecol Scand. 1997;76(10):928-32. doi:10.3109/00016349709034904 - Pubmed
- 7. Belfort M, Van Veen T, White G et al. Low Maternal Middle Cerebral Artery Doppler Resistance Indices Can Predict Future Development of Pre-Eclampsia. Ultrasound Obstet Gynecol. 2012;40(4):406-11. doi:10.1002/uog.11078 - Pubmed
- 8. Riskin-Mashiah S, Belfort M, Saade G, Herd J. Transcranial Doppler Measurement of Cerebral Velocity Indices as a Predictor of Preeclampsia. Am J Obstet Gynecol. 2002;187(6):1667-72. doi:10.1067/mob.2002.127594 - Pubmed
- 9. Belfort M, Giannina G, Herd J. Transcranial and Orbital Doppler Ultrasound in Normal Pregnancy and Preeclampsia. Clin Obstet Gynecol. 1999;42(3):479-506. doi:10.1097/00003081-199909000-00006 - Pubmed
- 10. Ozdemir M, Demirci O, Ozturkmen H, Ulusoy N, Ohanoglu K, Cilingir I. What Is the Role of the Maternal Ophthalmic and Cervical Internal Carotid Arteries in Predicting Maternal Adverse Outcomes in Preeclampsia? J Ultrasound Med. 2020;39(8):1527-35. doi:10.1002/jum.15241 - Pubmed