Overview
Definition
A pregnancy-specific hypertensive disorder occurring > 20 weeks gestation, characterized by new-onset hypertension and end-organ dysfunction (most commonly proteinuria).
Epidemiology
Affects 2-8% of pregnancies. A leading cause of maternal and perinatal morbidity.
Etiology & Risk Factors
- Abnormal placental spiral artery development leading to placental ischemia, which releases anti-angiogenic factors (sFlt-1) causing systemic maternal endothelial dysfunction.
Clinical Symptoms
- Often asymptomatic until severe
- Headache (refractory to Tylenol)
- Visual changes (scotomata, blurred vision)
- Right Upper Quadrant (RUQ) pain (due to liver capsule stretching)
- Swelling (facial and hands)
Clinical Approach
Diagnosis
- Blood Pressure: ≥ 140/90 on two occasions
- Proteinuria: ≥ 300mg in 24 hours OR Protein/Creatinine ratio ≥ 0.3
- Severe features: BP ≥ 160/110, Thrombocytopenia, elevated transaminases (AST/ALT), renal insufficiency (Cr > 1.1), pulmonary edema
Management
- Definitive treatment is DELIVERY
- Mild (without severe features): Expectant management until 37 weeks
- Severe features: Delivery at ≥ 34 weeks, Magnesium Sulfate (for seizure prophylaxis), BP control (IV Labetalol, Hydralazine, or Nifedipine)
Complications
- Eclampsia (new-onset generalized tonic-clonic seizures)
- HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)
- Placental abruption
- Fetal growth restriction / Fetal demise