Effects of preeclampsia on the mother, fetus and child

High blood pressure complicates almost 10 percent of all pregnancies, and the incidence is higher if the women are nulliparous or carrying multiple fetuses. Preeclampsia is a major cause of maternal mortality in developed and developing countries. It is also a major cause of perinatal morbidity and mortality, and it is very strongly associated with fetal growth retardation. Maternal impact Women who have or develop high blood pressure during pregnancy are all at increased risk of complications antenatally, intrapartum and in the puerperium. The increased risk applies to the mother as well to the fetus. Pregnant women with hypertension can be divided into two groups: normotensive women who develop the preeclamptic syndrome, which is characterised by hypertension, proteinuria, and edema; and women with chronic hypertension who become pregnant and are at a higher risk of developing superimposed preeclampsia. The impact of preeclampsia affects both mother and fetus, but it is important to differentiate between the complications of the disease from those inevitably associated to the drugs used for its treatment. Preeclampsia is the most serious form of hypertensive pregnancy complications, but it is not primarily a hypertensive disease; it is a disorder induced by factors based on the presence of placenta. Preeclampsia is initiated by abnormal placentation and, therefore, a low perfunded placenta, release of cytokines and other toxins, and vasoconstriction and platelet activation; so it is a syndrome of generalized endothelial dysfunction,and the complications are associated with the vascular system. Fundamentally, these complications are 1intravascular coagulation, bleeding and 2organ failure (hepatic and renal) following poor perfusion. 1There is a direct relationship between the decreased antithrombin III (ATIII) levels and the severity of the patient's clinical condition, especially after gestational weeks 30-32. Blood volume, by measurement of red blood cell and plasma volumes, is reduced and has altered distribution in preeclampsia. 2In hypertensive pregnancy, there is still controversy over the levels of proteinuria that should be considered pathological. As we have observed, preeclampsia has quite an impact on renal function (Table 1). Preeclampsia may be complicated by seizures: eclampsia. The greatest compromise occurs with the development of the HELLP syndrome (hemolysis, elevated liver enzimes and low platelet count). The HELLP syndrome, alongside preeclampsia, accounts for most maternal deaths associated with hypertension (Table 2). The process is completely reversed by the delivery of the fetus and placenta, but intrauterine growth retardation and premature delivery pose major threats to the fetus and may require care in a tertiary care center. Treatment of preexisting or pregnancy-induced hypertension does not prevent or reverse the process, but is justified to prevent maternal cardiovascular complications, especially during labor and delivery. The fetus is at increased risk due to growth retardation and hypoxia following placental damage. The majority of patients with mild chronic hypertension have successful pregnancy outcomes. Most perinatal morbidity is secondary to superimposed preeclampsia. Antihypertensive therapy does not appear to significantly affect pregnancy outcome, or the incidence of superimposed preeclampsia in mild chronic hypertensives. Maternal and fetal risks are considerably higher in severe chronic hypertension and in those patients with target organ disease. These patients should ideally be counseled regarding their risks prior to pregnancy Fetal impact