Hypertensive Disorder Complicating Pregnancy

Clinical findings — Edema

  • Dependent edema is a normal finding in pregnancy
  • Undependent edema of the hands and face present upon
  • Morning arising is considered pathologic
  • Weight gain in excess of 2kg/week or particularly sudden weight gain over 1 or 2 days should raise the suspicion of preeclampsia
  • Preeclampsia may occur without edema.（39% of eclamptic patients in one series had no edema.）

Clinical findings — Hypertension

  • Hypertension is the most important criterion for the diagnosis of preeclampsia
  • That too may occur suddenly
  • Many young primigravidas have 100-110/60-70mmHg duing the second trimester. An increase of 15mmHg or 30mmHg should be considered ominous
  • The blood pressure is often quite labile.It usually falls during sleep in patients with mild preeclampsia and chronic hypertension
  • But in patients with severe preeclampsia ，blood pressure may increase during sleep, eg, the most severe hypertion may occur at 2:00AM

Clinical findings — Proteinuria

  • Proteinuria is the last sign to develop
  • Eclampsia may occur without proteinuria. Sibai and associates found no proteinuria will have glomeruloendotheliosis on kidney biopsy
  • Proteinuria in preeclampsia is an indicator of fetal jeopardy
  • The incidence of SGA infants and perinatal mortality is markedly increased in patients with proteinuric preeclampsia

Clinical findings — Differing clinical picture

  • Preeclampsia-eclampsia is a multisystem disease with varying clinical presentations.
  • One patient may present with eclamptic seizures,
  • another with liver dysfunction and intrauterine growth retardation,
  • another with pulmonary edema,
  • stillanother with abruption placenta and renal failure