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Toxemia of pregnancy

Pre-eclampsia
Synonyms Pre-eclampsia toxaemia (PET), pre-eclampsia
Hypertrophic decidual vasculopathy high mag.jpg
A micrograph showing hypertrophic decidual vasculopathy, a finding seen in gestational hypertension and pre-eclampsia. H&E stain.
Specialty Obstetrics
Symptoms High blood pressure, protein in the urine
Complications Red blood cell breakdown, low blood platelet count, impaired liver function, kidney problems, swelling, shortness of breath due to fluid in the lungs, eclampsia
Usual onset After 20 weeks of pregnancy
Risk factors Obesity, prior hypertension, older age, diabetes mellitus
Diagnostic method BP > 140 mmHg systolic or 90 mmHg diastolic at two separate times
Prevention Aspirin, calcium supplementation, treatment of prior hypertension
Treatment Delivery, medications
Medication Labetalol, methyldopa, magnesium sulfate
Frequency 2–8% of pregnancies
Deaths 46,900 hypertensive disorders in pregnancy (2015)
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Pre-eclampsia laboratory values
Medical diagnostics
LDH/Uric Acid/AST/ALT/Plt/Cr
Shorthand for laboratory values commonly used in pre-eclampsia. LDH=Lactate dehydrogenase, Uric acid=Uric acid, AST=Aspartate aminotransferase, ALT=Alanine aminotransferase, Plt=Platelets, Cr=Creatinine.
Reference range LDH: 105–333 IU/L
Uric Acid: 2.4–6.0 mg/dL
AST: 5–40 U/L
ALT: 7–56 U/L
Plt: 140–450 x 109/L
Cr: 0.6–1.2 mg/dL
MeSH D007770
LOINC Codes for pre-eclampsia
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Classification
External resources

Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. The condition begins after 20 weeks of pregnancy. In severe disease there may be red blood cell breakdown, a low blood platelet count, impaired liver function, kidney dysfunction, swelling, shortness of breath due to fluid in the lungs, or visual disturbances. Pre-eclampsia increases the risk of poor outcomes for both the mother and the baby. If left untreated, it may result in seizures at which point it is known as eclampsia.

Risk factors for pre-eclampsia include obesity, prior hypertension, older age, and diabetes mellitus. It is also more frequent in a woman's first pregnancy and if she is carrying twins. The underlying mechanism involves abnormal formation of blood vessels in the placenta amongst other factors. Most cases are diagnosed before delivery. Rarely, pre-eclampsia may begin in the period after delivery. While historically both high blood pressure and protein in the urine were required to make the diagnosis, some definitions also include those with hypertension and any associated organ dysfunction. Blood pressure is defined as high when it is greater than 140 mmHg systolic or 90 mmHg diastolic at two separate times, more than four hours apart in a woman after twenty weeks of pregnancy. Pre-eclampsia is routinely screened for during prenatal care.

Recommendations for prevention include: aspirin in those at high risk, calcium supplementation in areas with low intake, and treatment of prior hypertension with medications. In those with pre-eclampsia delivery of the baby and placenta is an effective treatment. When delivery becomes recommended depends on how severe the pre-eclampsia and how far along in pregnancy a person is.Blood pressure medication, such as labetalol and methyldopa, may be used to improve the mother's condition before delivery.Magnesium sulfate may be used to prevent eclampsia in those with severe disease. Bedrest and salt intake have not been found to be useful for either treatment or prevention.


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