Hypertention in pregnancy

Hypertention in pregnancy
Subclassfiication of preecalmpsia
Abstract


Preeclampsia is a heterogenous disorder ,it is amaternal syndrome that arises through multiple pathways ,sub classification supported by at least on the basis of gestational age at disease onset.
Preecalmpsia and eclampsia remains one of the tow most common causes of maternal mortality in the developed world.
Preeclampsia incidence is 3-5 % of pregnancies ,and defined as hypertention of 140/90 mmhg or higher and protienuria equal to .3 g/24 hrs or higher that appear after 20 wks f gestation ,and regress after pregnancy there arec tow syndromes realated to peeclampsia : one maternal ,and fetal.

Mternal syndrome realated to reduced placental perfusion caused by abnormal placentation ,which
Manifests clinically in later pregnancy perhaps once the fetal =placental perfusion demands outstrip placental supplyand where the demands of the pregnancy above the capacity of the maternal
Arterial supply.
And arise in multipleprgnancy ,fetal growth , loss of functioning placental mass , in thrombophilia
Mismatched of intervilous space→→release factors such as (endothelial factors ) that leading to reduced placental perfusion .also accompanies intrauterine growth retardation and pretermbirth .
Preeclampsia associated mortality ,msost commonly due to hepatic necrosis or the acute respirator y
Distress syndrome , both are resultsof systemic inflammation.
The fetal syndrome is manifest by intrauterine growth restriction, fetal academia, and increased risk for both perinatal morbidity and mortality , particulary due to the ris of prematurity.

Preeclampsia classified into tow phases :Mild (B.p 140/90 mmHg,or higher ,proteinuria.3 –3G/DAY)
Severe ( B.p 160 and 170/100 and 110 , proteinuria 3-5 g/day and headache).
All classification predicted on the occurance of the hypertetion and protieuria ,neither of which is present in 10% of women within one week prior to their first eclamptic seizure,also gestational age at
Presentation is not a criterion for diagnosis ,severity ,or subclassification.


Early onset of preeclampsia:
The gestational age has nt been accounted for I any of the current classification systemas is amajor proplem onset pre eclampsia consider maternal risk ,as maternal mortality is some 20-fold higher at less than 32 weeks gestation than when preeclampsiaoccurs at term.
Onset preeclampsia quatitively different disease, this is supported by the pathophysiology of early onset of preeclampsia differ from late onset of disease in terms of neutrophil function and cytokines .there is evidence that of earl o . pre,. Defined as onset earlier than 28 wks , is associated with greater risk for recurrence in later pregnancies , and increased of cardiovascular disease and death .
Occurance of pre. Ec at less than `of 37 wks of gestation increased risk of death from cardiovascular disease by 7.1-8.1-fold. IUGR , pre eclampsi ,and preterm birth (less than 37 wks ) confers an adjusted hazard ratio for cardiovascular death of 16.1 (95% confidence interval 3.6 ,72.6)comared with normal pregnancy delivered.
Thus, gestational age is the most important determinant of perinatal out come,agreater than 50% intact fetus delivered of a women with preeclmpsia arises only when the gestational age at delivery is at or older than 27 wks and/ or the birth weight equal to or higher than 600 g.
In fact, recent data suggest that IUGR IS AFUNCTION OF PREECLAMPSIA ARISING BEFOR E 37 WKS GESTATION ,AND THAT THERE IS AN INCREASE IN LARGE BABIES AMONG WOMEN WITH PREECL AMPSIA DELEVERING AFTER THAN 37 WKS GESTATION .

FOR THIS REASON ,women with early onset of preeclampsia may providethe most homogeneouse
Data for differentiating the changes of preeclampsia from those of normal pregnancy .