Chapter 20. Preeclampsia

About 10% of pregnant women around the world have hypertension; in Russia, according to the Department of Health, the figure is 5-30%. Preeclampsia holds a special place in the structure of hypertensive conditions.

Preeclampsia (PE, from Greek eclampsia, lightning) is a multisystem abnormality manifested in the second half of pregnancy (after 20 weeks); it is characterized by arterial hypertension in combination with proteinuria (over 0.3 g/l in daily urine), often by edema and manifestations of multiple organ failure.

20.1. EPIDEMIOLOGY

Mild preeclampsia is noted in 3-18% of women; as a rule, it does not compromise the mother's or fetus's health. Among them, in 1-2% of pregnant women preeclampsia becomes severe. In 2013 in Russia preeclampsia complicated the course of 15.9% of pregnancies (Fig. 20.1).

Fig. 20.1. Dynamics of preeclampsia incidence rate in Russian Federation, %

The incidence rate of sever PE was 2.1% in 2005, and 1.5% in 2013. Severe PE affects the kidneys, liver, blood coagulation system and brain in the first place, as well as the fetoplacental system. Severe PE and eclampsia can seriously compromise the mother's and fetus's health and even result in a lethal outcome.

In advanced countries eclampsia is noted at a rate of 1/2000 pregnancies, in developing countries - at a rate of 1/100-1/1700 deliveries. Eclampsia and its complications persist as the main causes of maternal mortality around the world

(10-15%).

The share of PE in the structure of maternal mortality in Russian Federation is on the decline ceding the first place to somatic disease, hemorrhage and embolism; however, PE consistently accounts for 10% of deaths (Fig. 20.2).

Fig. 20.2. Structure of maternal mortality causes in Russian Federation, % (according to Department of Health, 2013)