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Pre-eclampsia: Symptoms, Causes, Diagnosis, Treatment & Prevention

Pre-eclampsia is a hypertensive disorder of pregnancy affecting 5–8% of pregnancies. It typically arises after 20 weeks and can progress rapidly. Early detection and management are critical.

Diagnostic Criteria (ACOG)

  • Blood pressure ≥140/90 mmHg on two occasions ≥4 hours apart (after 20 weeks in previously normotensive).
  • PLUS one or more: Proteinuria (≥300 mg/24hr or protein/creatinine ≥0.3), thrombocytopenia (<100K), renal insufficiency (Cr >1.1), impaired liver function (AST/ALT 2x normal), pulmonary edema, cerebral/visual symptoms.

Symptoms (Often Silent – That's Why Prenatal Checks Matter)

  • Severe headache (unrelieved by acetaminophen)
  • Visual changes: blurring, flashing lights, scotomas, photophobia
  • Upper abdominal pain (RUQ/epigastric) – liver capsule stretch
  • Nausea/vomiting (new onset, 2nd half)
  • Sudden swelling: face, hands, feet (beyond normal edema)
  • Rapid weight gain (>2 kg/week)
  • Shortness of breath
  • Decreased urine output

Risk Factors

  • First pregnancy, new partner
  • Chronic hypertension, kidney disease, diabetes, autoimmune (SLE, APS)
  • Multiple gestation
  • Age ≥35 or ≤15
  • Obesity (BMI ≥30)
  • IVF conception
  • Family/personal history
  • Black race (systemic inequities, not biology)
  • Low vitamin D, high stress

Severity Classification

  • Mild (Gestational Hypertension): BP ≥140/90 without severe features.
  • Severe Features: BP ≥160/110, symptoms above, lab abnormalities, fetal growth restriction.
  • Eclampsia: Seizures in pre-eclamptic woman.
  • HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets – variant, high morbidity.

Management

ScenarioManagement
Mild, <37 weeksOutpatient monitoring: BP checks 2x/week, labs weekly, fetal surveillance (NST/AFI), activity modification, aspirin if indicated.
Mild, ≥37 weeksDelivery recommended.
Severe, <34 weeksHospitalization, magnesium sulfate (seizure prophylaxis), antihypertensives (labetalol, nifedipine), steroids for lung maturity, delivery if maternal/fetal deterioration.
Severe, ≥34 weeksDelivery after stabilization.

Prevention

  • Low-dose Aspirin (81 mg): Start 12–16 weeks if ≥1 high-risk or ≥2 moderate-risk factors (USPSTF/ACOG). Reduces risk ~15%.
  • Optimize pre-pregnancy weight, blood pressure, glucose.
  • Calcium supplementation (1g/day) if dietary intake low.

Postpartum

Pre-eclampsia can develop up to 6 weeks postpartum. Monitor BP; long-term increased cardiovascular risk – annual follow-up.

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