Mechanisms of pathology development
The pathogenesis of preeclampsia unfolds in two stages:
- Placental level: defects in trophoblast invasion result in placental ischemia. This triggers oxidative stress and the release of inflammatory mediators.
- Organ level: a systemic bodily response manifesting as generalized endotheliosis. Blood vessels lose their normal regulatory capacity, leading to vasospasm and tissue hypoxia.
Ultimately, microcirculation suffers, which predictably progresses to multiple organ dysfunction syndrome (MODS).
Clinical Triad
The classic clinical picture includes three main signs:
- Hypertension: evaluated not only by absolute values, but also by the increase in BP relative to baseline levels.
- Proteinuria: a protein level starting from 0.3 g/L is considered diagnostically significant.
- Edema: distinguished from physiological edema by the development of nocturia and failure to resolve after rest.
Important: the onset of headache, visual disturbances, or epigastric pain indicates progression to a critical stage.
Eclampsia: seizure stages
Eclampsia is an "outburst" of seizure activity that proceeds through four phases:
| Phase | Characteristic |
|---|---|
| Introductory | Fibrillary facial twitching |
| Tonic | Spasm of all muscles, respiratory arrest |
| Clonic | Generalized convulsions |
| Resolution | Deep inspiration, restoration of breathing |
Post-seizure amnesia or progression into a comatose state is possible, which is an extremely unfavorable prognostic sign.
Briefly: answers to topical questions
Which disorders are classified as early toxicoses of pregnancy?
Early toxicoses of pregnancy comprise complications characterized by dyspeptic disorders and disturbances in all types of metabolism. The following groups of disorders are distinguished:
- Vomiting of pregnancy (emesis gravidarum) — the main form, which may be mild, moderate, or severe.
- Salivation (ptyalismus) — a frequent form accompanied by significant fluid loss.
- Rare forms — dermopathy (dermatosis), tetany, bronchial asthma, hepatosis, osteomalacia of pregnant women.
What are the severity grades of vomiting of pregnancy?
Vomiting of pregnancy has three degrees of severity: mild, moderate, and severe (hyperemesis). The severity of the condition is determined by a combination of attack frequency and the severity of metabolic disorders and vital organ dysfunctions.
| Sign | Mild | Mean | Severe (hyperemesis) |
|---|---|---|---|
| Frequency of vomiting per day | 3–5 times | 6–10 times | 11–15 times or more |
| Pulse rate, per minute | 80–90 | 90–100 | Over 100 |
| Systolic BP | 120–110 mm Hg | 110–100 mm Hg | Below 100 mm Hg |
What rare forms of early pregnancy toxicoses exist?
Rare forms of early pregnancy toxicoses include:
- Dermopathy (dermatosis).
- Tetany.
- Bronchial asthma.
- Hepatosis.
- Osteomalacia of pregnant women.
- Other rare forms.
What are the indications for pregnancy termination in early toxicoses?
An indication for emergency pregnancy termination is the lack of response to combination therapy in severe hyperemesis gravidarum.
Criteria for emergency termination:
- Lack of response to combination therapy for 3 days.
- Incessant vomiting.
- Progressive weight loss.
- Progressive ketonuria for 3–4 days.
- Pronounced tachycardia.
- Nervous system dysfunction: adynamia, apathy, delirium, euphoria.
- Bilirubinemia up to 40–80 µmol/L; hyperbilirubinemia of 100 µmol/L is critical.
- Ieteric coloration of the sclera and skin.
The "HPE" triad: Hypertension, Proteinuria, Edema — remember it as "Generalized Pathological Effect on the Organism".
Class and exam questions
What is non-convulsive eclampsia?
This is an extremely severe form in which, instead of seizures, coma develops against the background of high blood pressure, often accompanied by blindness (amaurosis) due to cerebral hemorrhage.
Which organs are primarily affected in preeclampsia?
The main target organs are the liver, kidneys, and brain.
Why is it important to monitor pulse pressure?
A decrease in pulse pressure below 40 mmHg indicates pronounced angiospasm and is a prognostically unfavorable sign.
What else to study on this topic
- The role of angiogenic factors (sFlt-1, PlGF) in diagnostics.
- Differential diagnosis of edema in pregnancy.
- Features of the course of eclampsia during labor and the postpartum period.
- Laboratory criteria for severe preeclampsia (liver enzymes, platelets).
- Pathophysiology of liver injury in HELLP syndrome.
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