â– LECTURE OVERVIEW: Preeclampsia is a multi-system, pregnancy-specific vasospastic disorder characterized by abnormal placental vascular remodeling.
â– BIOCHEMICAL PATHWAYS:
1. Spiral Artery Maladaptation: The primary defect is the failure of cytotrophoblasts to invade and remodel maternal spiral arteries. The arteries remain narrow, high-resistance vessels, leading to chronic placental ischemia.
2. Endothelial Injury: The ischemic placenta secretes anti-angiogenic factors (e.g., sFlt-1) that cause widespread maternal endothelial damage.
3. Systemic Vasospasm: Endothelial damage disrupts nitric oxide pathways, causing systemic vasospasm.
4. Glomerular Endotheliosis: Glomerular capillary endothelial swelling restricts filtration, presenting as proteinuria and elevated serum creatinine.
5. End-organ Vasoconstriction: Leads to cerebral edema (seizure risk), hepatic necrosis, and pulmonary edema.
â– CLINICAL COMPLICATIONS:
Delayed or incomplete treatment triggers cascading systemic strain, involving downstream organ failure, severe metabolic imbalances, or progressive tissue necrosis.
â– SECONDARY PREVENTION METRICS:
Implementing long-term dietary adaptations, physical therapy, and compliance aids reduces the rate of recurring acute crises by more than half.
[HY-BOARD-1227]
🌟 Dynamic Clinical Key:
Preeclampsia is diagnosed by new-onset hypertension (BP >140/90 mmHg) presenting after 20 weeks gestation, accompanied by proteinuria (>300 mg/24h) or end-organ dysfunction. Severe cases can progress to HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). Treat with IV Magnesium Sulfate for seizure prophylaxis. Early aggressive resuscitation is key to prevent irreversible multi-system organ dysfunction. Patient education regarding warning signs and therapy adherence is the cornerstone of secondary prevention.