PREECLAMPSIA

Predisposing factors: Aged 35 and above Family History of Hypertension and Diabetes Mellitus Increased Cardiac Output during Pregnancy Increased Blood Volume during Pregnancy

Precipitating Factors: Low socio-economic status Multiparity Traumatic Pregnancy

Systemic Vascular Spasms (vasospasm) See Line B Increased Peripheral Resistance Decreased Cardiac Output Tissue Hypoxia Multi-Organ Damage See Line A Decreased Blood Flow to the Gastrointestinal Tract Vasospasm in the Kidneys Pancreas Pancreatic Ischemia Epigastric Pain Liver Ischemia of Hepatic Cells Damaged Liver Function Increased Liver Enzymes, Jaundice Stomach, Small Intestine Decreased Gastric Motility Nausea Epigastric Pain Vomiting of Previously Ingested Food
Large Intestine Kidneys

Decreased Blood Flow to the Kidneys

If untreated
Decreased Blood Flow Resistance Increased Back Pressure Glomerular Damage See next page Tissue Hypoxia Increased Renin Production Activation of ReninAngiotensinFurther Rise in Blood Pressure Ischemia
Decreased Responsiveness to Tissue Hypoxia Decreased Erythropoeitin Production

Decreased Gastric Emptying Time

Constipation

Anemia

Glomerular Damage Line B Increased Permeability of Glomerular Membrane CHON in Urine Sugar in Urine Blood in Urine Decreased Glomerular Filtration Rate Decreased Urine Output and Creatinine Clearance Increased Tubular Reabsorption of Sodium Fluid Retention Edema Increased Hematocrit Line A Vasospasm in Renal Arteries Vision Changes Blurring of Vision Double Vision Retinal Hemmorhage Pre-term Labor Blindness Further Rise in Blood Pressure Decreased Bleeding Perfusion Increased Vasoconstricior Effects Increased Blood Pressure Placental Ischemia Early Placental Degeneration Fetal Death Disseminated Intravascualar Coagulation Excessive (paradoxical) bleeding Death Anemia Initially Thrombocytosis then Thrombocytopenia Increased Fibrin Production Formation of Fibrin Meshwork that Occludes Blood Vessels HELLP Syndrome Decreased Responsiveness to BP changes is Lost Increased Vasoconstriction and Platelet Aggregation Damage to Endothelial Cells of Arteries and Action of Prostaglandin . Decreased Prostaglandin and Increased Thromboxanes

Decreased maternal supply of nutrients and oxygen to fetus Fetal Compromise

Rupture and Hemolysis of RBC

If left untreated