Preeclampsia resident survival guide
Synonyms and keywords: Approach to preeclampsia , Approach to gestational hypertension with proteinuria

# Overview
Preeclampsia is primarily defined as gestational hypertension with proteinuria 300 mg or more over a 24-hour period. The pathophysiologic abnormalities of preeclampsia include placental ischemia, generalized vasospasm, abnormal hemostasis with activation of the coagulation system, vascular endothelial dysfunction, abnormal nitric oxide and lipid metabolism, leukocyte activation and changes in various cytokines as well as in insulin resistance. It is important to identify those with high risk of developing preeclampsia during their pregnancy for better management. Maternal and fetal outcomes in preeclampsia depend on one or more of these factors: gestational age at onset of preeclampsia as well as at time of delivery, the severity of the disease process, the presence of multifetal gestation, and the presence of other preexisting medical conditions such as diabetes, renal disease, or thrombophilias. It is associated with an increased risk of placental abruption, preterm birth, fetal intrauterine growth restriction (IUGR), acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular coagulation, and maternal death. Therefore, it is necessary to diagnose preeclampsia early.

# Causes
The high risk factors of preeclampsia are:
- History of any hypertensive disease during a previous pregnancy.
- Maternal disease such as chronic kidney disease, autoimmune diseases, diabetes, chronic hypertension.
Women are at moderate risk if they are:
- Nulliparous
- 40 years of age
- Have a Body mass index (BMI)  35 kg/m 
- Have a family history of preeclampsia
- Have a Multifetal pregnancy
- Have a A pregnancy interval of more than 10 years
Additional clinical factors associated with preeclampsia are :
- Raised mean arterial blood pressure before 15 weeks gestation
- Polycystic ovarian syndrome
- Sleep disordered breathing 
- Various infections such as periodontal disease,urinary tract infections and helicobacter pylori.
- Vaginal bleeding for at least five days during pregnancy increases preeclampsia risk
- Use of oocyte donation has a higher risk of preeclampsia than in vitro fertilization (IVF) without oocyte donation or natural conception.
Common causes of preeclampsia include uteroplacental ischemia and genetic predisposition due to the following:
- The formation of atheromatous plaques and fibrinoid necrosis of the spiral vessel walls
- Oxidative stress in trophoblast cells
- Apoptosis in trophoblast cells
- Systemic inflammatory response
- Vasospasm
- Platelet aggregation
- Thrombin formation
- Deposition of the fibrin in multiple organs

# Diagnosis
Shown below is an algorithm summarizing the diagnosis of Pre-eclampsia.
Abbreviations: BP: Blood pressure, RR=Respiratory rate,
HR=Heart Rate, OCP= Oral Contraceptive Pill, P :Cr=  Protein:Creatinine, sFlt-1= Soluble fms-like tyrosine kinase 1 , PlGF= placental growth factor, A:Cr= Albumin to Creatinine

# Treatment
Shown below is an algorithm summarizing the treatment of mild hypertension and preeclampsia.
Abbreviations: IV: Intravenous, IM= Intramuscular, IUGR= intrauterine growth restriction
Shown below is an algorithm summarizing the treatment of severe preeclampsia.

# Dos
- Patient should start low-dose aspirin if she has two or more moderate risk factors.
- If a woman had preeclampsia during a previous pregnancy, the patient should maintain a healthy weight and make sure other conditions such as diabetes, are well managed before getting pregnant.
- Once a woman is pregnant  with history of previous preeclampsia, the patient should complete early and regular prenatal care visits.
- If a pregnant woman has swelling, severe headache, changes in vision or other symptoms of preeclampsia, she should contact the doctor immediately.
- It is important to start leading a healthy lifestyle which includes maintaining a healthy weight, exercising regularly, eating a well-balanced diet, not smoking or not using alcohol.

# Don'ts
- It's important that a pregnant woman does not take any medications, vitamins or supplements without first talking to her doctor.