Feature of Pre-eciampsia includes all except: (PGI May 2011)
Ans : C (Vomiting) SEVERE PREECLAMPSIA Harrison 17th/44It is the presence of new-onset hypertension and proteinuria accompanied by central nervous system [CNS) dysfunction (headaches, blurred vision, seizures, coma), marked elevations of blood pressure (>160/110 mmHg), severe proteinuria (>5 g/24h), oliguria or renal failure^', pulmonary- edema', hepatocellular injury (ALT > 2 x the upper limits of normal), thrombocytopenia (platelet count < 100,000/L), or disseminated intravascular coagulation.The HELLP (hemolysis, elevated liver enzymes, low- platelets) syndrome is a special subgroup of severe preeclampsia and is a major cause of morbidity and mortality in this disease. The presence of platelet dysfunction and coagulation disorders further increases the risk of strokeNoteWomen with mild preeclampsia are those with the diagnosis of new-onset hypertension, proteinuria, and edema without evidence of severe preeclampsia.Table (William's Obstetrics)Diagnosis of Hypertensive Disorders Complicating Pregnancy Gestational hypertensionBP >140/90 mm Hg for first time during pregnancyNo proteinuriaBP returns to normal <12 weeks' postpartumFinal diagnosis made only postpartumMay have other signs or symptoms of preeclampsia, for example, epigastric discomfort or thrombocytopenia PreeclampsiaMinimum criteriaBP >140/90 mm Hg after 20 weeks' gestationProteinuria 2300 mg/24 hours or >1+ dipstickIncreased certainty of preeclampsiaBP 160/110 mg HgProteinuria 2.0 g/24 hours or >2+ dipstickSerum creatinine >1.2 mg/dL unless known to be previously elevatedPlatelets < 100,000/mm3Microangiopathic hemolysis (increased LDH)Elevated ALT or ASTPersistent headache or other cerebral or visual disturbancePersistent epigastric pain EclampsiaSeizures that cannot be attributed to other causes in a woman with preedampsiaSuperimposed Preeclampsia (on chronic hypertension)New-onset proteinuria >300 mg/24 hours in hypertensive women but no proteinuria before 20 weeks' gestationA sudden increase in proteinuria or blood pressure or platelet count < 100,000/mm3 in women with hypertension and proteinuria before 20 weeks' gestation Chronic HypertensionBP >140/90 mm Hg before pregnancy or diagnosed before 20 weeks' gestation not attributable to gestational trophoblastic diseaseorHypertension first diagnosed after 20 weeks' gestation and persistent after 12 weeks' postpartum
B.P > 140/90 after 20 wk
Epigastric pain
Vomiting
Visual disturbance & heartburn
Pathophysiology