Actualización 2008 sobre Preeclampsia a cargo de la En esta clase se presentó una conferencia de gran calidad sobre PREECLAMPSIA y ejemplos sobre preguntas tipo ECAES, a cargo de la DRA. Merly Muñoz Espinosa Residente Gineco – Obstetricia,USCO 2008.

1. PREECLAMPSIA DRA. MERLY MUÑOZ ESPINOSA GINECO – OBSTETRICIA USCO 2008

3. PREECLAMPSIA SEVERA PREECLAMPSIA New onset proteinuric hypertension and at least one of the following: Blurred vision, scotomata, altered mental status, severe headache Symptoms of central nervous system dysfunction Right upper quadrant or epigastric pain Nausea, vomiting Symptoms of liver capsule distention Serum transaminase concentration at least twice normal Hepatocellular injury Systolic blood pressure ≥ 160 mm Hg or diastolic ≥ 110 mm Hg (two at least six hours) Severe blood pressure elevation Less than 100,000 platelets per cubic millimeter Thrombocytopenia 5 or more grams in 24 hours Proteinuria <500 mL in 24 hours Oliguria Severe fetal growth restriction Pulmonary edema or cyanosis Cerebrovascular accident

6. FACTORES DE RIESGO PREECLAMPSIA Unexplained fetal growth restriction Hydrops fetalis Male partner whose previous partner had preeclampsia High body mass index 2.93 Multifetal gestation 3.56 Diabetes mellitus (pregestational and gestational) Vascular or connective tissue disease Antiphospholipid antibody syndrome or inherited thrombophilia Chronic renal disease Chronic hypertension 2.90 Family history of pregnancy-induced hypertension 1.96 Age >40 years or <18 years 7.19 Preeclampsia in a previous pregnancy 25-75% Nulliparity RELATIVE RISK FACTOR

7. PATOGENESIS PREECLAMPSIA SYSTEMIC ENDOTHELIAL DYSFUNCTION Fms–like tyrosine kinase-1 Vascular endothelial growth factor Antagonizes placental growth factor Hypothesis for the role of sFlt1 in preeclampsia

8. PATOGENESIS PREECLAMPSIA Stereographic representation of myometrial and endometrial arteries in the macaque

9. PATOGENESIS PREECLAMPSIA Exchange of oxygen, nutrients, and waste products between the fetus and the mother depends on adequate placental perfusion by maternal vessels. Abnormal placentation in preeclampsia Hypoperfusion

10. PATOGENESIS PREECLAMPSIA

28. COMPLICACIONES CVC PREECLAMPSIA Nerve injury Myocardial perforation Catheter embolization Catheter migration Venous thrombosis, pulmonary emboli Infection DELAYED Pneumothorax or hemothorax Catheter malposition Thoracic duct injury (with left SC or left IJ approach) Air embolism Arrhythmia Arterial puncture Bleeding IMMEDIATE

44. RESULTADOS PREECLAMPSIA Adapted from data in Hauth, JC, Ewell, MG, Levine, RJ, et al. Obstet Gynecol 2000; 95:24 0.9 0.5 0.5 Neonatal death 0.9 0.5 0.9 Fetal death 0 0.5 0.2 Brain hemorrhage 15.7 3.2 3.8 Respiratory difficulty 42.6 27.3 12.9 Admission to NICU 18.5 10.2 4.2 Growth restriction Fetal or neonatal 18.5 1.9 3.2 Delivery <34 weeks 34.9 30.9 13.3 Cesarean delivery 58.7 41.5 12.1 Induced labor 3.7 0.5 0.7 Placental abruption 12.8 5.1 0.3 Kidney dysfunction 20.2 3.2 0.2 Liver dysfunction Maternal Severe preeclampsia (percent) Mild preeclampsia (percent) Normal blood pressure, (percent) Outcome measure