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7 - Pre-eclampsia and hypertensive disorders of pregnancy

Published online by Cambridge University Press:  21 August 2009

Alexander Heazell  and
John Clift
By
Egidio da Silva  and
Wilson Chimbira
Alexander Heazell
Affiliation:
University of Manchester
John Clift
Affiliation:
City Hospital, Birmingham
Egidio da Silva
Affiliation:
Specialist Registrar in Anaesthesia and Intensive care University Hospitals, Birmingham, Queen Elizabeth Hospital, Birmingham, UK
Wilson Chimbira
Affiliation:
Lecturer in Anaesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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Summary

Introduction

Pre-eclampsia is a multi-system disorder, which primarily affects the cardiovascular system, leading to dysfunction of liver, lungs, kidney and brain. Pre-eclampsia is unpredictable in presentation and progression. At present, there is no curative treatment for pre-eclampsia and the ultimate management is the delivery of the fetus and placenta. Pre-eclampsia can present at any time after the 20th week of gestation, and is an important cause of iatrogenic prematurity, with the associated perinatal morbidity and mortality. In cases of extreme prematurity, pregnancy is prolonged until maternal health is at risk. Success in the management of pre-eclampsia is dependent at least in part on a multidisciplinary approach by the midwifery, obstetric, anaesthetic, intensive care and neonatal teams.

In the UK, pre-eclampsia has an incidence of between 3% and 5%, with severe pre-eclampsia complicating 0.5% of pregnancies. Eclampsia affects only 0.05% of pregnancies in the UK. It is estimated that 1 in 6 stillbirths and 14% of maternal mortality are due to pre-eclampsia and hypertensive disorders of pregnancy.

Aetiology and pathogenesis

Pre-eclampsia is related to placental pathology, probably arising from decreased trophoblast invasion in the first trimester. This reduction in invasion fails to convert the convoluted spiral arteries to high-flow, low-resistance vessels that feed the placenta, thus decreasing placental blood flow, which may result in placental hypoxia and oxidative stress. It is hypothesised that the damaged placenta releases active factor(s) into the maternal circulation that results in endothelial damage and vasoconstriction within the maternal vasculature (Figure 7.1).

Keywords

Caesarean sectioncardiovascular systemfluid resuscitationhypertensionintra-uterine growth restrictionpre-eclampsiaintra-uterine fetal death
Type
Chapter
Information
Obstetrics for Anaesthetists , pp. 70 - 87
Publisher: Cambridge University Press
Print publication year: 2008

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References

J. E. Myers and J. Brockelsby, The epidemiology of pre-eclampsia. In Baker, P. N. and Kingdom, J. C. P. eds., Pre-eclampsia: Current Perspectives on Management (London: Parthenon, 2004), pp. 25–39.
Tuffnell, D. J., Jankowicz, D., Lindow, S. W.et al., Outcomes of severe pre-eclampsia/eclampsia in Yorkshire 1999–2003. Br. J. Obstet. Gynaecol., 112:7 (2005), 875–80.Google Scholar
Confidential Enquiry into Maternal and Child Health, Why Mothers Die 2000–2002 – The Sixth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom (London: Royal College of Obstetricians and Gynaecologists Press, 2004).
Mushambi, M. C., Halligan, A. W. and Williamson, K., Recent developments in the pathophysiology and management of pre-eclampsia. Br. J. Anaesth., 76 (1996), 133–48.Google Scholar
Davey, D. A. and MacGillivray, I., The classification and definition of the hypertensive disorders of pregnancy. Am. J. Obstet. Gynecol., 158:4 (1988), 892–8.Google Scholar
Wagner, L. K., Diagnosis and management of pre-eclampsia. Am. Fam. Physician 70:12 (2004), 2317–24.Google Scholar
Milne, F., Redman, C., Walker, J.et al., The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. BMJ, 330:7491 (2005), 576–80.Google Scholar
Barton, J. R., O'Brien, J. M., Bergauer, N. K., Jacques, D. L. and Sibai, B. M., Mild gestational hypertension remote from term: progression and outcome. Am. J. Obstet. Gynecol., 184:5 (2001), 979–83.Google Scholar
Royal College of Obstetricians and Gynaecologists. The Management of Severe Pre-eclampsia/Eclampsia. Guideline 10(A) (London: Royal College of Obstetricians and Gynaecologists Press, 2006).
Impey, L., Severe hypotension and fetal distress following sublingual administration of nifedipine to a patient with severe pregnancy induced hypertension at 33 weeks. Br. J. Obstet. Gynaecol., 100 (1993), 959–61.Google Scholar
Duley, L., Gulmezoglu, A. M. and Henderson-Smart, D. J., Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst. Rev., 3 (2006), CD000025.Google Scholar
Altman, D., Carroli, G., Duley, L.et al., Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet, 359:9321 (2002), 1877–90.Google Scholar
Clark, S. L., Greenspoon, J. S. and Aldahl, D., Severe pre-eclampsia with persistent oliguria: management of hemodynamic subsets. Am. J. Obstet. Gynecol., 154 (1986), 490–4.Google Scholar
James, M. F. M., Magnesium in obstetric anesthesia. Int. J. Obstet. Anesth., 7(1998), 115–23.Google Scholar
Practice Guidelines for Obstetrical Anesthesia. Anesthesiology, 90 (1999), 600–11.
Walker, J. J.Severe pre-eclampsia and eclampsia. Best Pract. Res. Clin. Obstet. Gynaecol., 14 (2000), 57–71.Google Scholar

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