topic: #on/emergencymedicine created: 2024-09-02 *Increased risk for the mother and baby by a multi-system illness, the repercussions of which start around 20 weeks and end years later.* ##### what is it? “hypertension that develops after 20 weeks of gestation with proteinuria or 274 evidence of end-organ damage, such as an abnormal renal function test, an elevation of liver 275 enzymes, or thrombocytopenia without proteinuria.” (Erez et al., 2022, p. 12) ##### why does it matter? My previous mental model of this disease was that it was defined by edema, proteinuria, and hypertension. Now I know that preeclampsia is a multi-system illness with risks to the mother and the fetus. _It can even happen in the absence of hypertension in the form of HELLP syndrome._ The common organs involved are blood vessel (hypertension, intracranial hemorrhage), Brain (stroke, seizure), liver (elevated liver enzymes), kidney (proteinuria, elevated creatinine - remember that proteinuria is unreliable on dipstick), retina (visual changes, retinal detachment), pancreas (pancreatitis), heart (congestive heart failure), lungs (pulmonary edema, ARDS).![[Preeclampsia effect on different organs.jpg]] (Erez et al., 2022) **Early and late preeclampsia are different illnesses** They are often divided at 34 weeks gestation, expectant management should not occur after 34 weeks in women with preeclampsia with severe features. Induction is recommended as the ultimate treatment. Whereas early preeclampsia should be managed with medications to reduce risk of poor maternal outcome. **Postpartum eclampsia** “We propose that postpartum 450 preeclampsia and eclampsia belong to a group of conditions of unknown etiology that occur after delivery in a fraction of patients, which include peripartum cardiomyopathy, renal failure, uremic hemolytic syndrome, and acute fatty liver.” (Erez et al., 2022, p. 20) ##### This reminds me of It is best thought of the way severe anaphylaxis is thought of, the presence of multiple organ involvement is the key to the diagnosis. “Pregnancy has been labelled as a stress test which unveils women with cardiovascular dysfunction or poor reserve” (Odukoya et al., 2021, p. 3) ##### What would the opposite argument be? Is the definition becoming too broad? You don't even need proteiunuria? Possibly the best way of thinking about this is that is a vascular disease of women, exposed during pregnancy, but with life-long implications. “Hypertension can be considered an adaptive response of an injured placenta” (Erez et al., 2022, p. 16) Why treat? “pharmacologic treatment of maternal hypertension does not 349 improve fetal outcomes.” (Erez et al., 2022, p. 16) **Part of a lifetime of vascular dysfunction that some women endure** “Framed in this way, the understanding of the nature of vascular dysfunction during pregnancy would allow the health care system to focus on the prevention of cardiovascular disease in women throughout their lifespan.” (Erez et al., 2022, p. 24) “The large body of evidence in support of associations between PE and increased future CVD risks for both the mother and offspring are overwhelming. As the search for total understanding of this global maternal and foetal menace continues, it is expedient that a strict follow-up of both mother and child, before (if possible), during and after the index pregnancy be observed, with obligatory composite lifestyle adjustments.” (Odukoya et al., 2021, p. 11) %% tags: #note/idea | #on/emergencymedicine %% ##### Sources: Erez, O., Romero, R., Jung, E., Chaemsaithong, P., Bosco, M., Suksai, M., Gallo, D. M., & Gotsch, F. (2022). Preeclampsia and eclampsia: The conceptual evolution of a syndrome. _American Journal of Obstetrics and Gynecology_, _226_(2), S786–S803. [https://doi.org/10.1016/j.ajog.2021.12.001](https://doi.org/10.1016/j.ajog.2021.12.001) Odukoya, S. A., Moodley, J., & Naicker, T. (2021). Current Updates on Pre-eclampsia: Maternal and Foetal Cardiovascular Diseases Predilection, Science or Myth?: Future cardiovascular disease risks in mother and child following pre-eclampsia. _Current Hypertension Reports_, _23_(3), 16. [https://doi.org/10.1007/s11906-021-01132-x](https://doi.org/10.1007/s11906-021-01132-x)