Preeclampsia: Pathophysiology, management, and maternal and fetal sequelae

Preeclampsia is a unique, complicated problem of pregnancy that is prevalent worldwide. The maternal effects of severe disease may involve multiple organ systems. Consequences of disease for the infant include possible prematurity, fetal growth restriction, placental abruption, or intrauterine fetal demise. In addition, long-termeffects of disease have been studied in both mothers and children. Although the exact cause of preeclampsia is not fully understood, increasing evidence points to abnormal placentation and an imbalance of antiangiogenic factors. Specifically, soluble Fms-like tyrosine kinase-1 has been investigated as the link between poor placental invasion and maternal disease. Clinically, maternal disease is defined as the presence of elevated blood pressure after 20 weeks' gestation and proteinuria. The presence of severe symptoms or abnormal laboratory test results separate mild and severe disease. Studies have shown that delivery should occur at 37 weeks' gestation with mild disease and 34 weeks' gestation with severe disease. In early-onset severe disease, expectant management with close monitoring is possible if maternal and fetal status remain stable. Pathophysiology, diagnosis criteria, management, and possible maternal and fetal complications are reviewed.