Toxemia and Preeclampsia Eclampsia

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Pregnancy-induced hypertension (toxemia) is seen late in pregnancy and remains a major medical challenge. Five to 10% of pregnant women with toxemia may develop preeclampsia (hypertension plus proteinuria and nonde-pendent edema). Preeclampsia generally occurs during the second and third trimesters, and is most frequent in young primagravidas. Risk factors associated with preeclampsia include nulliparity, a positive family history, preeclamp-sia in a prior pregnancy, obesity, chronic hypertension or renal disease, diabetes mellitus, a multiple gestation pregnancy, low socioeconomic status, and cigarette smoking.

The cause of preeclampsia is unknown. Laboratory abnormalities are nonspecific. Hepatic involvement is seen in 10 to 30% of women with preeclampsia. Mild elevations ofserum transaminases and, rarely, an increase in indirect bilirubin can be seen in the absence of HELLP syndrome. Histologically, periportal fibrin deposition and hemorrhage with hepatocellular necrosis are seen (Figure 120-2). Preeclampsia can also have a similar histological pattern to AFLP (both may develop microvesicular steatosis).

The clinical course may be mild or rapidly progressive. Onset of seizures signals development of true eclampsia (usually young primagravidas), accounting for approximately 8% of all maternal deaths. Control of the hypertension is associated with reduced morbidity and mortality in both the mother and the fetus. Definitive therapy requires delivery.

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