Obstetrics & Gynecology
Preeclampsia
임신중독증(전자간증)
New-onset hypertension after 20 weeks with proteinuria/end-organ damage
- How common
- 5–8% of pregnancies
- Typical age
- Higher risk <18 and >35
What is it?
Defective trophoblast invasion fails to remodel spiral arteries → placental ischemia → release of anti-angiogenic factors (sFlt-1) → systemic endothelial dysfunction.
Commonly affected: Kidneys, liver, brain, placenta, coagulation
How it develops
- Shallow trophoblast invasionSpiral arteries fail to dilate adequately
- Placental ischemiaHypoperfusion → oxidative stress
- Anti-angiogenic factorssFlt-1 and sEng rise; PlGF/VEGF fall
- Endothelial dysfunctionVasospasm, proteinuria, edema, multi-organ injury
Symptoms
- Hypertension≥140/90 on 2 readings; severe ≥160/110
- Proteinuria24-hr ≥300 mg or P/Cr ≥0.3
- Headache/visual changesSevere features: throbbing headache, photopsia, blurring
- RUQ/epigastric painLiver capsule stretch (HELLP possible)
- EdemaFacial/hand, rapid weight gain
How it is examined
- Repeat BP measurement≥140/90 on 2 readings 4 h apart
- Lab workupCBC, AST/ALT, Cr, LDH, urine protein, PT
- Fetal assessmentNST, BPP, growth US
Imaging
CXR to assess pulmonary edema in severe disease.
- Pulmonary edema
- Pleural effusion
Brain MRI for seizures: assess PRES (posterior reversible encephalopathy).
- Posterior edema
- T2 hyperintensity
Non-surgical care
- Magnesium sulfateSeizure prophylaxis: 4–6 g IV load → 1–2 g/h
- AntihypertensivesLabetalol/hydralazine/nifedipine for SBP ≥160 or DBP ≥110
- Antenatal corticosteroidsBetamethasone 12 mg IM × 2 (24 h apart) if <34 weeks
- Strict monitoringDaily vitals, proteinuria, labs, fetal assessment
- Low-dose aspirin81 mg/day from 12–16 wk in high-risk women
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
37 weeks reached or severe features (≥160/110, HELLP, AKI, fetal distress)
Procedures that may be discussed
- Induction of labor
- Cesarean section if obstetric indication
- Definitive treatment: delivery of placenta
Outlook
Resolves after delivery; future cardiovascular/renal risk and recurrence risk in next pregnancy.