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Preeclampsia. Part 1: Clinical and Pathophysiologic Considerations

Pridjian, Gabriella MD*; Puschett, Jules B. MD†

Obstetrical & Gynecological Survey: September 2002 - Volume 57 - Issue 9 - pp 598-618
CME Program: Category 1 CME Review Article 26

Preeclampsia-eclampsia is still one of the leading causes of maternal and fetal morbidity and mortality. Despite active research for many years, the etiology of this disorder exclusive to human pregnancy is an enigma. Recent evidence suggests there may be several underlying causes or predispositions leading to the signs of hypertension, proteinuria, and edema, findings that allow us to make the diagnosis of the “syndrome” of preeclampsia. Despite improved prenatal care, severe preeclampsia and eclampsia still occur. Although understanding of the pathophysiology of these disorders has improved, treatment has not changed significantly in over 50 years. Although postponement of delivery in selected women with severe preeclampsia improves fetal outcome to a degree, this is not done without risk to the mother. In the United States, magnesium sulfate and hydralazine are the most commonly used medications for seizure prophylaxis and hypertension in the intrapartum period. The search for the underlying cause of this disorder and for a clinical marker to predict those women who will develop preeclampsia-eclampsia is ongoing, with its prevention the ultimate goal. This review begins with the clinical and pathophysiologic aspects of preeclampsia-eclampsia (Part 1). In Part 2, the experimental observations, the search for predictive factors, and the genetics of this disorder will be reviewed.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader will be able to summarize the clinical aspects of preeclampsia-eclampsia, to outline the classification of hypertensive disorders during pregnancy, and to list the factors associated with the development of preeclampsia.

*Associate Professor, Departments of Obstetrics & Gynecology and Pediatrics and Human Genetics Program and †Professor and Chairman, Department of Medicine, Tulane University Medical School, New Orleans, Louisiana

Reprint requests to: Gabriella Pridjian, MD, Division of Maternal-Fetal Medicine, Dept. of Obstetrics & Gynecology, SL11, Tulane University Medical School, 1430 Tulane Avenue, New Orleans, LA 70112. Email: Gabriella.Pridjian@Tulane.edu

The authors have disclosed no significant financial or other relationship with any commercial entity.

© 2002 Lippincott Williams & Wilkins, Inc.