Eclampsia: morbidity, mortality, and management.

Introduction Pre-eclampsia is a multisystem disorder of pregnancy and the puerperium, complicating approximately 6% to 8% of all pregnancies in developed nations. Pre-eclampsia may be defined by the clinical diad of new onset hypertension (sitting blood pressure $140 mm Hg systolic or $90 mm Hg diastolic) and proteinuria ($1+ in a random urine sample or $300 mg in a 24-hour collection). It may also be accompanied by clinical symptoms after 20 weeks’ gestation. These include an unremitting headache, visual changes, right upper quadrant pain, midepigastric pain, nausea and vomiting, oliguria, and shortness of breath. Each of these symptoms herald potentially severe clinical manifestations, including intracerebral hemorrhage, hypertensive encephalopathy, hepatic involvement (including hematoma or capsular rupture), renal failure, and pulmonary edema. Pre-eclampsia may be subdivided into 2 categories, mild and severe, by virtue of the severity of the hypertension and proteinuria, as well as by the presence of unremitting symptoms as a manifestation of other organ involvement. In the most recent publication of the National High Blood Pressure Education ProgramWorking Group on High Blood Pressure in Pregnancy, the previously used traditional defining criteria of edema ($2+ pretibial, facial, or presacral edema) and proteinuria (mild identified as $300 mg in a 24-hour collection, severe as $5 g) in a 24-hour collection have been altered in the diagnosis and distinction of mild and severe forms of the disorder. Alternatively, current guidelines suggest that ‘‘Proteinuria is defined as the urinary excretion of 0.3 g protein or greater in a 24-hour specimen. This will usually correlate with 30 mg/dL (‘‘1+ dipstick’’) or greater in a random urine determination with no evidence of urinary tract infection. However, because of the discrepancy between random protein determinations and 24-hour urine protein in pre-eclampsia (which may be either higher or lower), it is recommended that the diagnosis be based on a 24-hour urine if possible or a timed collection corrected for creatinine Correspondence:Michael A. Belfort,MD,PhD, 1200East 3900 South, Salt Lake City, UT 84124. E-mail: uvmbelfo@ ihc.com