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VOLUME 25 , ISSUE S3 ( December, 2021 ) > List of Articles


Preeclampsia and Related Problems

Amit M Narkhede

Keywords : Cerebral venous sinus thrombosis, Disseminated intravascular coagulation, Hypertensive emergency, Maternal mortality, Obstetric critical care, Preeclampsia, Pregnancy

Citation Information :

DOI: 10.5005/jp-journals-10071-24032

License: CC BY-NC 4.0

Published Online: 12-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Hypertensive disorders of pregnancy can be classified as chronic hypertension (present before pregnancy), gestational hypertension (onset after 20 weeks of pregnancy), and preeclampsia (onset after 20 weeks of pregnancy, along with proteinuria and other organ dysfunction). Preeclampsia and related disorders are a major cause of maternal and fetal morbidity and mortality. Preeclampsia is believed to result from an angiogenic imbalance in the placenta circulation. Antenatal screening and early diagnosis may help improve outcomes. Severe preeclampsia is characterized by SBP ≥160 mm Hg, or DBP ≥110 mm Hg, thrombocytopenia (platelet count <100 × 109/L), abnormal liver function, serum creatinine >1.1 mg/dL, or a doubling of the serum creatinine concentration in the absence of other renal diseases, disseminated intravascular coagulation, pulmonary edema, new-onset headache, or visual disturbances. Severe preeclampsia or eclampsia (preeclampsia with seizures) needs ICU management and is the main cause of morbidity and mortality. Severe hypertension can also result in life-threatening intracranial hemorrhage. Blood pressure control, seizure prevention, and appropriate timing of delivery are the cornerstones of the management of preeclampsia. Besides intravenous antihypertensive drugs, intravenous magnesium sulfate is the drug of choice to prevent or treat seizures, when preparing for urgent delivery. At present, delivery remains the most effective treatment for preeclampsia, and organ dysfunction rapidly recovers after delivery. Novel therapeutic interventions are under development to reduce complications.

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  1. Karnad DR, Guntupalli KK. Critical illness and pregnancy: review of a global problem. Crit Care Clin 2004;20(4):555–576. DOI: 10.1016/j.ccc.2004.05.001.
  2. Munnur U, Karnad DR, Bandi VDP, Lapsia V, Suresh MS, Ramshesh P, et al. Critically ill obstetric patients in an American and an Indian public hospital: comparison of case-mix, organ dysfunction, intensive care requirements, and outcomes. Intensive Care Med 2005;31(8):1087–1094. DOI: 10.1007/s00134-005-2710-5.
  3. Karnad DR, Lapsia V, Krishnan A, Salvi VS. Prognostic factors in obstetric patients admitted to an Indian intensive care unit. Crit Care Med 2004;32(6):1294–1299. DOI: 10.1097/01.ccm.0000128549.72 276.00.
  4. Mamatha K. A study on obstetric admissions to HDU/ICU in a tertiary care centre. Indian J Obstet Gynecol 2019;7(2):177–181. DOI: 10.21088/ijog.2321.1636.7219.9.
  5. Gupta H, Gandotra N, Mahajan R. Profile of obstetric patients in intensive care unit: a retrospective study from a tertiary care center in North India. Indian J Crit Care Med 2021;25(4):388–391. DOI: 10.5005/jp-journals-10071-23775.
  6. Say L, Chou D, Gemmill A, Tunçalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Global Health 2014;2(6):e323–e333. DOI: 10.1016/S2214-109X(14)70227-X.
  7. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384(9947):980–1004. DOI: 10.1016/S0140-6736(14) 60696-6.
  8. American College of Obstetricians and Gynecologists. Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin Number 222: gestational hypertension and preeclampsia. Obstet Gynecol 2020;135(6):e237–e260. DOI: 10.1097/AOG.0000000000003892.
  9. Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol 2019;15(5):275–289. DOI: 10.1038/s41581-019-0119-6.
  10. Roberts JM, Redman CW. Pre-eclampsia: more than pregnancy-induced hypertension. Lancet 1993;341(8858):1447–1451. DOI: 10.1016/0140-6736(93)90889-o.
  11. Karnad DR, Guntupalli KK. Neurologic disorders in pregnancy. Crit Care Med 2005;33(10):S362–S371. DOI: 10.1097/01.ccm. 0000182790.35728.f7.
  12. Chappell LC, Cluver CA, Kingdom J, Tong S. Pre-eclampsia. Lancet 2021;398(10297):341–354. DOI: 10.1016/S0140-6736(20)32335-7.
  13. Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol 2020;S0002-9378(20)30873-5. DOI: 10.1016/j.ajog.2020.08.045.
  14. Guntupalli KK, Hall N, Karnad DR, Bandi V, Belfort M. Critical illness in pregnancy: part I: an approach to a pregnant patient in the ICU and common obstetric disorders. Chest 2015;148(4):1093–1104. DOI: 10.1378/chest.14-1998.
  15. McLaughlin K, Scholten RR, Kingdom JC, Floras JS, Parker JD. Should maternal hemodynamics guide antihypertensive therapy in preeclampsia? Hypertension 2018;71(4):550–556. DOI: 10.1161/HYPERTENSIONAHA.117.10606.
  16. Shekhar S, Gupta N, Kirubakaran R, Pareek P. Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta-analysis. BJOG 2016;123(1):40–47. DOI: 10.1111/1471-0528.13463.
  17. Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002;359(9321):1877–1890. DOI: 10.1016/s0140-6736(02)08778-0.
  18. Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet 2009;374(9694):979–988. DOI: 10.1016/S0140-6736(09)60736-4.
  19. Broekhuijsen K, van Baaren GJ, Van Pampus MG, Ganzevoort W, Sikkema JM, Woiski MD, et al. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. Lancet 2015;385(9986):2492–2501. DOI: 10.1016/S0140-6736(14)61998-X.
  20. Mirkovic L, Tulic I, Stankovic S, Soldatovic I. Prediction of adverse maternal outcomes of early severe preeclampsia. Pregnancy Hypertension 2020;22:144–150. DOI: 10.1016/j.preghy.2020.09.009.
  21. Sabiri B, Moussalit A, Salmi S, El Youssoufi S, Miguil M. Post-partum eclampsia: epidemiology and prognosis. J Gynecol Obstet Biol Reprod 2007;36(3):276–280. DOI: 10.1016/j.jgyn.2006.12.025.
  22. Rath W, Faridi A, Dudenhausen JW. HELLP syndrome. J Perinat Med 2000;28(4):249–260. DOI: 10.1515/JPM.2000.033.
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