Preeclampsia
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Chronic Illnesses The woman contemplating a pregnancy who has a chronic illness should seek the advice of her physician. Examples of such illnesses include asthma, high blood pressure, and heart and kidney disease. The physician’s goal will be to optimize the health status for the existing illness prior to pregnancy, and alert the woman to any additional risks. SEE ALSO: Diet, Exercise, Immunization, Pregnancy, Prenatal care, Toxoplasmosis
Suggested Reading Frey, K. A. (2002). Preconception care by the nonobstetrical provider. Mayo Clinic Proceedings, 77(5), 469–473. Frey, K. A. (2002). Preconception care. Primary Care Reports, 8(25), 222–227.
KEITH A. FREY
Preeclampsia Preeclampsia, otherwise known as “toxemia,” is a disease unique to pregnancy that affects approximately 5–8% of all pregnant women. Preeclampsia is part of the spectrum of hypertensive disorders of pregnancy, which accounts for approximately 18% of all maternal deaths in the United States.
By definition, preeclampsia is unique to pregnancy and usually occurs after 20 weeks’ gestation. Preeclampsia has traditionally been diagnosed clinically with a triad of signs including two of the following three: edema (swelling), hypertension (high blood pressure), and proteinuria (protein in the urine). The edema is significant if it occurs in the face and hands (as opposed to legs and feet), but this has recently become the least important symptom in the diagnosis. Preeclampsia can be associated with a dramatic weight gain over a short period of time. Hypertension is defined as two blood pressure readings of greater than 140/90 taken in the seated position greater than 6 hr apart. Prior to 20 weeks’ gestation, an elevation in blood pressure is usually unrelated to the woman being pregnant, and preeclampsia is a disease that typically occurs later than 20 weeks’ gestation. Proteinuria is defined as ⱖ300 mg protein in a 24-hr collection of urine or greater than or equal to 1⫹ protein dipped on a clean catch urine. Risks factors for developing preeclampsia include: first pregnancy; more than one fetus (twins, triplets, etc.); having had preeclampsia in a prior pregnancy; diabetes; molar pregnancies; chronic hypertension; systemic lupus erythematosus (SLE); kidney disease; obesity; older age; thrombophilias (blood clotting disorders); and family history. The exact etiology of preeclampsia is unclear, but we have some clues. For example, preeclampsia is not only unique to pregnancy, but it is also unique to the placenta versus the fetus. This is demonstrated by the fact that molar pregnancies (without fetal tissue) are at high risk for preeclampsia as well as pregnancies complicated by abnormal placentas. There is evidence that changes of preeclampsia start as early as the first trimester of pregnancy with abnormal blood vessels in the early placental tissue. This may predispose a patient to release of “toxins,” hence the older term toxemia. The only cure for preeclampsia is delivery or evacuation of the uterus. However, preeclampsia may be temporized depending
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