Anesthesia for Obstetrics and Gynecology - Preeclampsia
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Preeclampsia is a common diagnosis occurring in approximately 5% of pregnancies, particularly in nulliparous, diabetic, hypertensive patients or those with chronic disease. Persistent hypertension after 20 weeks of gestational age should prompt a diagnostic workup for preeclampsia (Table 32.2). Recent changes in the diagnostic criteria do not require the presence of proteinuria for the diagnosis, and since fetal growth restriction is similarly managed in the absence of preeclampsia, it has been eliminated as a finding of severe preeclampsia. Although the etiology is incompletely understood, anomalous placentation with failure of trophoblastic invasion and up-regulation of placental factor sFlt-1 (a soluble tyrosine kinase that inhibits blood vessel growth) leads to diffuse maternal endothelial damage.