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Preeclampsia

MedGen UID:
18608
Concept ID:
C0032914
Finding; Pathologic Function
Synonyms: Edema Proteinuria Hypertension Gestosis; Edema-Proteinuria-Hypertension Gestosis; EPH Complex; EPH Gestosis; EPH Toxemia; EPH Toxemias; Gestosis, Edema-Proteinuria-Hypertension; Gestosis, EPH; Gestosis, Hypertension-Edema-Proteinuria; Gestosis, Proteinuria-Edema-Hypertension; Hypertension Edema Proteinuria Gestosis; Hypertension-Edema-Proteinuria Gestosis; Of Pregnancies, Toxemia; Of Pregnancy, Toxemia; Pre Eclampsia; Pre-Eclampsia; Pregnancies, Toxemia Of; Pregnancy Toxemia; Pregnancy Toxemias; Pregnancy, Toxemia Of; Proteinuria Edema Hypertension Gestosis; Proteinuria-Edema-Hypertension Gestosis; Toxemia Of Pregnancies; Toxemia Of Pregnancy; Toxemia, EPH; Toxemia, Pregnancy; Toxemias, EPH; Toxemias, Pregnancy
SNOMED CT: Pre-eclampsia (398254007); EPH - Edema, proteinuria and hypertension of pregnancy (398254007); PET - Pre-eclamptic toxemia (398254007); Pre-eclamptic toxemia (398254007); PE - Pre-eclampsia (398254007); Proteinuric hypertension of pregnancy (398254007); Preeclampsia (398254007); Toxemia of pregnancy (398254007)
Modes of inheritance:
Not genetically inherited
MedGen UID:
988794
Concept ID:
CN307044
Finding
Source: Orphanet
clinical entity without genetic inheritance.
 
HPO: HP:0100602
Monarch Initiative: MONDO:0005081
OMIM® Phenotypic series: PS189800
Orphanet: ORPHA275555

Definition

Preeclampsia is a complication of pregnancy in which affected women develop high blood pressure (hypertension); they can also have abnormally high levels of protein in their urine (proteinuria). This condition usually occurs in the last few months of pregnancy and often requires early delivery of the infant. However, this condition can also appear shortly after giving birth (postpartum preeclampsia).

Women who have had preeclampsia have approximately twice the lifetime risk of heart disease and stroke than do women in the general population. Researchers suggest that preeclampsia, heart disease, and stroke may share common risk factors. Women who have diseases such as obesity, hypertension, heart disease, diabetes, or kidney disease before they become pregnant have an increased risk of developing preeclampsia. Preeclampsia is most likely to occur in a woman's first pregnancy, although it can occur in subsequent pregnancies, particularly in women with other health conditions.

Many women with mild preeclampsia do not feel ill, and the condition is often first detected through blood pressure and urine testing in their doctor's office. In addition to hypertension and proteinuria, signs and symptoms of preeclampsia can include excessive swelling (edema) of the face or hands and a weight gain of more than 3 to 5 pounds in a week due to fluid retention. Affected women may also experience headaches, dizziness, irritability, shortness of breath, a decrease in urination, upper abdominal pain, and nausea or vomiting. Vision changes may develop, including flashing lights or spots, increased sensitivity to light (photophobia), blurry vision, or temporary blindness.

In many cases, symptoms of preeclampsia go away within a few days after the baby is born. In severe cases, however, preeclampsia can damage the mother's organs, such as the heart, liver, and kidneys, and can lead to life-threatening complications. Extremely high blood pressure in the mother can cause bleeding in the brain (hemorrhagic stroke). The effects of high blood pressure on the brain (hypertensive encephalopathy) may also result in seizures. If seizures occur, the condition is considered to have worsened to eclampsia, which can result in coma. About 1 in 200 women with untreated preeclampsia develop eclampsia. Eclampsia can also develop without any obvious signs of preeclampsia.

Between 10 and 20 percent of women with severe preeclampsia develop another potentially life-threatening complication called HELLP syndrome. HELLP stands for hemolysis (premature red blood cell breakdown), elevated liver enzyme levels, and low platelets (cells involved in blood clotting), which are the key features of this condition.

Severe preeclampsia can also affect the fetus, with impairment of blood and oxygen flow leading to growth problems or stillbirth. Infants delivered early due to preeclampsia may have complications associated with prematurity, such as breathing problems caused by underdeveloped lungs. [from MedlinePlus Genetics]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVPreeclampsia
Follow this link to review classifications for Preeclampsia in Orphanet.

Professional guidelines

PubMed

Obstet Gynecol 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J
Circulation 2019 Jun 18;139(25):e1082-e1143. Epub 2018 Nov 10 doi: 10.1161/CIR.0000000000000625. PMID: 30586774Free PMC Article
Obstet Gynecol 2019 Jan;133(1):1. doi: 10.1097/AOG.0000000000003018. PMID: 30575675

Curated

UK NICE guideline (NG133), Hypertension in pregnancy: diagnosis and management, 2023

Recent clinical studies

Etiology

Chang KJ, Seow KM, Chen KH
Int J Environ Res Public Health 2023 Feb 8;20(4) doi: 10.3390/ijerph20042994. PMID: 36833689Free PMC Article
Wang Y, Li B, Zhao Y
Front Immunol 2022;13:883404. Epub 2022 Jul 8 doi: 10.3389/fimmu.2022.883404. PMID: 35880174Free PMC Article
Melchiorre K, Giorgione V, Thilaganathan B
Am J Obstet Gynecol 2022 Feb;226(2S):S954-S962. Epub 2021 Mar 24 doi: 10.1016/j.ajog.2020.10.024. PMID: 33771361
Kattah A
Curr Hypertens Rep 2020 Sep 14;22(11):91. doi: 10.1007/s11906-020-01099-1. PMID: 32926258
Bokslag A, van Weissenbruch M, Mol BW, de Groot CJ
Early Hum Dev 2016 Nov;102:47-50. Epub 2016 Sep 20 doi: 10.1016/j.earlhumdev.2016.09.007. PMID: 27659865

Diagnosis

Dimitriadis E, Rolnik DL, Zhou W, Estrada-Gutierrez G, Koga K, Francisco RPV, Whitehead C, Hyett J, da Silva Costa F, Nicolaides K, Menkhorst E
Nat Rev Dis Primers 2023 Feb 16;9(1):8. doi: 10.1038/s41572-023-00417-6. PMID: 36797292
MacDonald TM, Walker SP, Hannan NJ, Tong S, Kaitu'u-Lino TJ
EBioMedicine 2022 Jan;75:103780. Epub 2021 Dec 23 doi: 10.1016/j.ebiom.2021.103780. PMID: 34954654Free PMC Article
Melchiorre K, Giorgione V, Thilaganathan B
Am J Obstet Gynecol 2022 Feb;226(2S):S954-S962. Epub 2021 Mar 24 doi: 10.1016/j.ajog.2020.10.024. PMID: 33771361
Ramos JGL, Sass N, Costa SHM
Rev Bras Ginecol Obstet 2017 Sep;39(9):496-512. Epub 2017 Aug 9 doi: 10.1055/s-0037-1604471. PMID: 28793357Free PMC Article
Bokslag A, van Weissenbruch M, Mol BW, de Groot CJ
Early Hum Dev 2016 Nov;102:47-50. Epub 2016 Sep 20 doi: 10.1016/j.earlhumdev.2016.09.007. PMID: 27659865

Therapy

Liu YH, Zhang YS, Chen JY, Wang ZJ, Liu YX, Li JQ, Xu XJ, Xie NJ, Lye S, Tan N, Duan CY, Wei YX, He PC
Am J Obstet Gynecol 2023 May;228(5):535-546. Epub 2022 Oct 23 doi: 10.1016/j.ajog.2022.10.014. PMID: 36283479
Rolnik DL, Nicolaides KH, Poon LC
Am J Obstet Gynecol 2022 Feb;226(2S):S1108-S1119. Epub 2020 Aug 21 doi: 10.1016/j.ajog.2020.08.045. PMID: 32835720
Khaing W, Vallibhakara SA, Tantrakul V, Vallibhakara O, Rattanasiri S, McEvoy M, Attia J, Thakkinstian A
Nutrients 2017 Oct 18;9(10) doi: 10.3390/nu9101141. PMID: 29057843Free PMC Article
Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH
N Engl J Med 2017 Aug 17;377(7):613-622. Epub 2017 Jun 28 doi: 10.1056/NEJMoa1704559. PMID: 28657417
Bartsch E, Medcalf KE, Park AL, Ray JG; High Risk of Pre-eclampsia Identification Group
BMJ 2016 Apr 19;353:i1753. doi: 10.1136/bmj.i1753. PMID: 27094586Free PMC Article

Prognosis

Lawrence ER, Klein TJ, Beyuo TK
Obstet Gynecol Clin North Am 2022 Dec;49(4):713-733. doi: 10.1016/j.ogc.2022.07.001. PMID: 36328676
Atallah A, Lecarpentier E, Goffinet F, Doret-Dion M, Gaucherand P, Tsatsaris V
Drugs 2017 Nov;77(17):1819-1831. doi: 10.1007/s40265-017-0823-0. PMID: 29039130Free PMC Article
Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, Zaman A, Fryer AA, Kadam U, Chew-Graham CA, Mamas MA
Circ Cardiovasc Qual Outcomes 2017 Feb;10(2) Epub 2017 Feb 22 doi: 10.1161/CIRCOUTCOMES.116.003497. PMID: 28228456
Abalos E, Cuesta C, Grosso AL, Chou D, Say L
Eur J Obstet Gynecol Reprod Biol 2013 Sep;170(1):1-7. Epub 2013 Jun 7 doi: 10.1016/j.ejogrb.2013.05.005. PMID: 23746796
Hutcheon JA, Lisonkova S, Joseph KS
Best Pract Res Clin Obstet Gynaecol 2011 Aug;25(4):391-403. Epub 2011 Feb 18 doi: 10.1016/j.bpobgyn.2011.01.006. PMID: 21333604

Clinical prediction guides

Stepan H, Galindo A, Hund M, Schlembach D, Sillman J, Surbek D, Vatish M
Ultrasound Obstet Gynecol 2023 Feb;61(2):168-180. doi: 10.1002/uog.26032. PMID: 35816445
Rasmussen M, Reddy M, Nolan R, Camunas-Soler J, Khodursky A, Scheller NM, Cantonwine DE, Engelbrechtsen L, Mi JD, Dutta A, Brundage T, Siddiqui F, Thao M, Gee EPS, La J, Baruch-Gravett C, Santillan MK, Deb S, Ame SM, Ali SM, Adkins M, DePristo MA, Lee M, Namsaraev E, Gybel-Brask DJ, Skibsted L, Litch JA, Santillan DA, Sazawal S, Tribe RM, Roberts JM, Jain M, Høgdall E, Holzman C, Quake SR, Elovitz MA, McElrath TF
Nature 2022 Jan;601(7893):422-427. Epub 2022 Jan 5 doi: 10.1038/s41586-021-04249-w. PMID: 34987224Free PMC Article
MacDonald TM, Walker SP, Hannan NJ, Tong S, Kaitu'u-Lino TJ
EBioMedicine 2022 Jan;75:103780. Epub 2021 Dec 23 doi: 10.1016/j.ebiom.2021.103780. PMID: 34954654Free PMC Article
Guedes-Martins L
Adv Exp Med Biol 2017;956:409-417. doi: 10.1007/5584_2016_82. PMID: 27722963
Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, Olovsson M, Brennecke SP, Stepan H, Allegranza D, Dilba P, Schoedl M, Hund M, Verlohren S
N Engl J Med 2016 Jan 7;374(1):13-22. doi: 10.1056/NEJMoa1414838. PMID: 26735990

Recent systematic reviews

Zhang S, Han X, Liu W, Wen Q, Wang J
Arch Gynecol Obstet 2023 Jul;308(1):63-71. Epub 2022 Aug 1 doi: 10.1007/s00404-022-06718-7. PMID: 35913558
Roberge S, Bujold E, Nicolaides KH
Am J Obstet Gynecol 2018 Mar;218(3):287-293.e1. Epub 2017 Nov 11 doi: 10.1016/j.ajog.2017.11.561. PMID: 29138036
Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, Zaman A, Fryer AA, Kadam U, Chew-Graham CA, Mamas MA
Circ Cardiovasc Qual Outcomes 2017 Feb;10(2) Epub 2017 Feb 22 doi: 10.1161/CIRCOUTCOMES.116.003497. PMID: 28228456
Bartsch E, Medcalf KE, Park AL, Ray JG; High Risk of Pre-eclampsia Identification Group
BMJ 2016 Apr 19;353:i1753. doi: 10.1136/bmj.i1753. PMID: 27094586Free PMC Article
Abalos E, Cuesta C, Grosso AL, Chou D, Say L
Eur J Obstet Gynecol Reprod Biol 2013 Sep;170(1):1-7. Epub 2013 Jun 7 doi: 10.1016/j.ejogrb.2013.05.005. PMID: 23746796

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
    • Bookshelf
      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    • NICE, 2023
      UK NICE guideline (NG133), Hypertension in pregnancy: diagnosis and management, 2023

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