What does preeclampsia mean

pre-eclampsia

Synonyms: EPH gestosis, EPH syndrome, late gestosis, pregnancy poisoning
English: preeclampsia

1 definition

As pre-eclampsia denotes the occurrence of hypertension and proteinuria during pregnancy. Preeclampsia is a possible preliminary stage of eclampsia and must therefore be recognized as early as possible.

2 ICD10 codes

  • O14.-: Gestational hypertension [pregnancy-induced] with significant proteinuria
  • O14.0: Moderate preeclampsia
  • O14.1: Severe preeclampsia
  • O14.9: preeclampsia, unspecified

3 etiology

The exact causes of preeclampsia have not yet been fully clarified at the moment (2019). Genetic and immunological factors are discussed - both on the maternal and paternal side. The main pathogenetic trigger is probably a disturbed invasion of the trophoblast, which leads to an incorrect development of the placental vascular system. The spiral arteries do not grow sufficiently into the myometrium and the remodeling of the small spiral arteries into large-lumen vessels does not occur. Overall, this leads to an increase in uteroplacental vascular resistance.

4 pathophysiology

Preeclampsia is a complex pathophysiological process in which basically all of the mother's organ systems can be affected.

The kidneys are affected by a decrease in GFR of up to 50% of the initial value, which can be expressed as oliguria. In some of the cases, the liver becomes involved and coagulation disorders develop. Possible changes are hemolysis, increase in transaminases, thrombocytopenia and consumption coagulopathy with hypofibrinogenemia and an increase in D-dimers. Some of these complications are known as HELLP syndrome (Hemolysis, E.levated L.iver enzymes, L.ow P.latelets).

Possible fetal complications of preeclampsia include stunted growth, premature placental detachment and, in the worst case, death of the unborn child.

Preeclampsia can suddenly turn into eclampsia with maternal seizures. In the case of eclampsia, the child and maternal prognosis is again considerably worse.

5 risk factors

If one or more of the following factors are present, your risk of preeclampsia is increased:

6 symptoms

The cardinal symptoms of preeclampsia are:

  • Hypertension (> 140/90 mmHg or increase by 30 mmHg systolic and 15 mmHg diastolic)
  • Proteinuria (> 0.3 g / day in the 24-hour urine collection)

In addition to the term preeclampsia, there is also the disease term EPH gestosis, which is outdated according to new classifications, which also leads to the formation of edema as a symptom.

From one severe Eclampsia is spoken when the following constellation of findings is present:

7 diagnostics

7.1 Basic diagnostics

7.2 PlGF and sFlT-1

In women with preeclampsia, changes in serum levels for PIGF, the "placental growth factor", and sFlt-1 (soluble fms-like tyrosine kinase-1), also known as VEGF receptor-1, are found. In addition, by detecting the PlGF and sFlt-1 concentrations in the blood, a normal pregnancy can be narrowed down from a pregnancy associated with preeclampsia even before the onset of clinical symptoms.

In a normal pregnancy, the pro-angiogenic factor PlGF increases during the first two trimesters and decreases towards the end of the pregnancy. In contrast, the anti-angiogenic factor sFlt-1 remains the same during the early and middle stages of pregnancy. After that, it increases steadily until the end of the pregnancy.

In women who develop preeclampsia, higher sFlt-1 concentrations and lower PlGF concentrations were found than in normal pregnancies. The sFlt-1 / PlGF quotient is a better predictor of preeclampsia than the respective determination of the biomarker on its own.

8 therapy

If you have eclampsia in late pregnancy, childbirth is indicated. This can be done by induction of labor as normal delivery or by caesarean section.

If preeclampsia occurs before the 32nd week of pregnancy, blood pressure adjustment (beta blockers, alpha-methyldopa) can be aimed for after hospital admission. Careful fluid balance is essential to preventing pulmonary edema. Fetal lung maturation therapy with glucocorticoids (induces surfactant formation) should also be carried out in the meantime. Prophylaxis of seizures can be carried out by the intravenous administration of magnesium sulfate under close clinical controls (muscle reflexes, respiratory rate) and serum level determinations.

However, if any complications arise, delivery should be recommended in these cases as well. Advances in neonatology have significantly improved the prognosis for premature births.