Preeclampsia & eclampsia – causes, symptoms, diagnosis, treatment, pathology
23
August

By Adem Lewis / in , , , , , , , , , , , , , , , , , , /


Preeclampsia is a disorder that only happens
in pregnant women – it occurs after 20 weeks’ gestation, and in some cases develops up to
6 weeks after delivery. Preeclampsia causes new-onset hypertension
and proteinuria – protein in the urine, which is a marker of kidney damage – and can also
cause damage to other organs like the brain and liver. There can be a wide range of symptoms – for
some women there may be no symptoms or only mild ones, whereas for others, it can turn
into a life-threatening illness. If a woman with preeclampsia develops seizures,
she is said to have eclampsia. Preeclampsia tends to occur more often during
a first pregnancy, in pregnancies with multiple gestations, or in mothers 35 years or older. Other risk factors include having hypertension,
diabetes, obesity, or a family history of preeclampsia. Okay but why do these changes happen in preeclampsia
and eclampsia? Well, the exact cause is unclear, a key pathophysiologic
feature though is the development of an abnormal placenta. Normally, during pregnancy, the spiral arteries
dilate to 5-10 times their normal size and develop into large uteroplacental arteries
capable of delivering large quantities of blood to the developing fetus. In preeclampsia, these uteroplacental arteries
become fibrous causing them to narrow, which means less blood gets to the placenta. A poorly perfused placenta can lead to intrauterine
growth restriction and even fetal death in severe cases. At this point, the hypoperfused placenta starts
releasing pro-inflammatory proteins. These thenn get intol the mother’s circulation
and cause the endothelial cells that line her blood vessels to become dysfunctional. Endothelial cell dysfunction causes vasoconstriction
– narrowing of the blood vessels – and also affects the kidneys in a way that makes them
retain more salt, both of which result in hypertension. When diagnosing preeclampsia, hypertension
is defined as a systolic blood pressure of 140 mmHg or greater or diastolic blood pressure
of 90 mmHg or greater. In severe preeclampsia, systolic blood pressure
can be 160 mmHg or greater and diastolic blood pressure can be 110 mmHg or greater. These extreme blood pressures can lead to
a hemorrhagic stroke or placental abruption, in which the placenta detaches prematurely
from the uterine wall. There can also be local areas of vasospasm
– which means that less blood might reach certain parts of the body. For example, reduced blood flow to the kidneys,
which are particularly susceptible, can cause glomerular damage leading to oliguria – very
little urine – and proteinuria . Normally, the glomeruli of the kidneys do a good job
of preventing protein from spilling into the urine, so proteinuria can be a sign of glomerular
damage and is a classic sign of preeclampsia. Reduced blood flow to the retina can cause
blurred vision, the sensation of seeing flashing lights, and the development of a scotoma. A scotoma is when a small part of the visual
field has slightly worse visual acuity – a bit like having a blurry spot on an otherwise
normal computer monitor. Reduced blood flow to the liver can cause
severe liver injury and swelling, which can cause an elevation in liver enzymes and stretches
out the capsule around the liver. Stretching of the liver capsule typically
causes right upper quadrant pain, or epigastric pain, which is one of the cardinal symptoms
of severe preeclampsia. Endothelial injury also leads to the formation
of lots of tiny thrombi in the microvasculature, a process that uses up massive amounts of
platelets. Having all of these tiny blood clots in the
blood is a bit like having dozens of boulders in the middle of a fast moving river. It becomes treacherous for red blood cells
to navigate through, and before long, they slam up against a clot and get destroyed – a
process called hemolysis. Together these make up HELLP syndrome (H=hemolysis,
EL=elevated liver enzymes, LP=low platelets). HELLP syndrome develops in about 10 to 20%
of women with severe preeclampsia or eclampsia. Finally, endothelial injury increases vascular
permeability, allowing water to slip out of blood vessels between neighboring endothelial
cells and get into the tissues. Because there’s also a loss of protein from
the blood due to the proteinuria, even more fluid moves from the blood vessels into the
tissues. This causes generalized edema which is often
seen in the legs, face and hands; pulmonary edema which can cause cough and shortness
of breath; and cerebral edema which can cause headache, confusion, and seizures. Seizures define the onset of eclampsia. Because all of the problems of preeclampsia
and eclampsia stem from placental dysfunction, the ultimate treatment is delivery of the
fetus and placenta. The decision to induce delivery depends heavily
on the gestational age of the fetus as well as the severity of the disease and how it’s
affecting both maternal and fetal health. If the onset of symptoms comes after delivery,
then the goal is to manage the symptoms which slowly subside on their own. Additional measures are aimed at managing
any end-organ damage by offering supplemental oxygen, medication to manage seizures, and
other complications like stroke or placental abruption. As a quick recap, preeclampsia is a disorder
that occurs after 20 weeks’ gestation and up to 6 weeks following delivery. It is defined by a new onset of hypertension
and proteinuria but can affect many organs, particularly the kidneys, eyes, liver, and
brain. Eclampsia is diagnosed when a patient with
preeclampsia develops seizures. Thanks for watching, you can help support
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100 thoughts on “Preeclampsia & eclampsia – causes, symptoms, diagnosis, treatment, pathology

  1. before i even start this video i just want to say thank you so much cos i have obstetrics exam in two days and i always watch your videos for all courses actually.straight to the point, informative and totally brilliant. God bless .love from russia

  2. You are my heroes been turning pages for ages and didn't get anything… Few minutes down this video and all makes sense

  3. Those downvotes are from the companies ya'll are putting out of business. Guaranteed. Osmosis is the winner in my book.

  4. My mums mother died of this. My mum was about 4 when her mum died. I just wanted to see what it actually is

  5. I love all osmosis vedios. Its a great support in my medical education. Thank you. I really like the way of explaining and voice of the explainer.

  6. Hello! Excellent video, but there is an error in 3:25 saying that blurred vision is called scotoma, and scotoma is when you see a black spot in the visual field. All in the sake to improve education 🙂
    Thanks for making these videos, we really appreciate them.

  7. Plzzz do the vidio In all the subjects…your explanation is the best thing that we have ever seen…this channel is amazing for medical purposes..

  8. I've notice that most of your videos do not mention the exact recommended medications that is use for the management of disease which is a bit sad because otherwise the series would've been complete recap for medical students. Like for this video, at least the mentioning of magnesium sulfate, calcium channel blocker would have been nice.

  9. Try pronouncing your words instead of blowing through it them in the same fashion you blow your boyfriends

  10. I like your channel. It helps medical students and non med people in understanding diseases. How to work with you? Haha

  11. That was great. Well done. It certainly cemented eclampsia and preeclampsia in my mind. Thanks for the broader explanation of why BP increases, why edema develops and the systemic and organ damage that can occur. Thanks again.

  12. How proteinuria occurs when there is glomerular endotheliosis – which do not allow even water to pass …. Somebody please explain

  13. The aesthetics is fundamental in educational videos, few get that, you do, this is brilliant and beautifuly done. Keep up the good work.

  14. Not always the case though because I had eclampsia after my pregnancy and I wasn’t even diagnosed with pre-eclampsia during. I’ve suffered from seizures and multiple strokes every pregnancy after

  15. I had severe preeclampsia with my second, including the epigastric and my blood pressure when they decided for a emergency induction was 220/110. What are my chances of getting it again?

  16. Thank you so much for posting this. My BP as been around 148/101 and 152/96 with protein in urine. Waiting for my doctor appointment this morning. I hope they decide to induce. I'm worried about waiting and becoming more ill.

  17. I have a question. Is placental abruption part of preeclampsia? If it is, how does placental abruption connects to preeclampsia in your pathophysiology?

  18. Delivery = parto.
    Up to = até.
    Kidney = rim.
    Liver = fígado.
    Range = gama, alcance.
    Mild = leve.
    Whereas = enquanto.
    Seizure = convulsão.
    To narrow = estreitar.
    Vessel = vaso.
    Hemorrhagic Stroke = derrame cerebral.
    To detache = destacar.
    To swell = inchar.
    Onset = início.
    Tissue = tecido.
    To slip = deslizar.

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