Complications
Fetal growth restriction is found in around 30% of women with pre-eclampsia.[8] If the uterus is small for dates, this implies that the amniotic fluid volume is reduced, which may signify fetal growth restriction.
Fetal ultrasound assessment is required. Fetal biometry should be used to diagnose or exclude fetal growth restriction, although growth can only be fully assessed by scans done 2 weeks apart.
Although some experts see this as the main complication, and treatment is directed towards preventing this complication, in practice it does not present the main risk to the mother. Not all women develop eclampsia.
With the judicious use of magnesium sulfate, the incidence can be reduced, but not prevented.
Largely a postnatal event indicated by breathlessness, but can be diagnosed early with the use of a pulse oximeter (O₂ saturation monitor), which is the best measure of fluid overload.
Can be prevented by careful fluid management.[15]
If present before delivery, left ventricular function defects should be excluded by echocardiogram.
Untreated systolic hypertension poses the greatest risk of stroke.[2]
There is also evidence to suggest that the risk of pregnancy-associated stroke is increased in women with pre-eclampsia and one or more of the following: infections, chronic hypertension, coagulopathies, or underlying prothrombotic conditions.[112] These women are likely to require closer monitoring.[112]
Prevented by management of blood pressure.
Associated with sudden fetal demise and severe complications to the mother.
Seems to be associated with untreated systolic hypertension, so reduced incidence may be owing to improved care.
Generally presents as acute abdominal pain, enlarging uterus, vaginal bleeding of varying degree, and cardiovascular changes.
If the baby is alive, quick delivery and emptying of the uterus is needed. Delay can lead to fetal demise. A worsening abruption leads to coagulation defects, haemorrhage, and major problems with fluid management.
If the baby has died in utero, a vaginal delivery can be considered as long as coagulation parameters and bleeding are stable.
An indication for invasive cardiovascular monitoring.
A history of early preterm pre-eclampsia is associated with increased risk of chronic kidney disease, hypertensive kidney disease, and glomerular and proteinuric disease in later life.[104]
Short-term renal failure (usually acute tubular necrosis) is associated with sepsis and abruption; most women usually recover.
Maternal death from renal failure is very rare in the developed world because of the availability of supportive measures such as fluid management and dialysis.[15][83]
In resource-poor settings, renal failure as a sole complication is still rare, but is associated with the multiple organ failure that occurs in prolonged untreated disease and can contribute to death.[83]
Fetal morbidity and mortality are largely dependent on the function of the placenta and the gestational age at delivery.
Placental insufficiency leads to growth restriction, but rarely to fetal death in later gestations. Growth restriction is more likely to lead to intrauterine death in early gestations because of an attempt to prolong the pregnancy through delayed delivery.
The main cause of morbidity and mortality is iatrogenic premature delivery owing to the severity of the disease.
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