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[The clinical and anatomical aspects of preeclampsia: current features of its course]
L M Mikhaleva1, N A Gracheva2, A E Biryukov1
1Research Institute of Human Morphology, Moscow, Russia; City Clinical Hospital Thirty-One, Moscow Healthcare Department, Moscow, Russia.
Insights
Preeclampsia often presents atypically, with edema being common but significant hypertension and proteinuria less so. Characteristic findings include thrombocytopenia, liver dysfunction, and severe organ damage, aiding diagnosis.
Area of Science:
- Obstetrics and Gynecology
- Pathology
- Maternal Health
Background:
- Preeclampsia is a major global cause of maternal and perinatal mortality.
- It involves complex etiopathogenesis with clinical, laboratory, and morphological changes.
- The classic triad of hypertension, proteinuria, and edema is not always present.
Purpose of the Study:
- To investigate the clinical and anatomical features of preeclampsia in contemporary cases.
- To identify diagnostic markers for preeclampsia in maternal deaths.
Main Methods:
- Analysis of 17 maternal deaths attributed to preeclampsia between 2012 and 2017.
- Postmortem examinations conducted at City Clinical Hospital Thirty-One, Moscow.
Main Results:
- Atypical preeclampsia presentation observed, often without significant hypertension or proteinuria, but with edema.
- Key laboratory findings included thrombocytopenia and liver enzyme dysfunction.
- Morphological findings revealed frequent brain hemorrhages, shock kidney with endotheliosis and cortical necroses, liver damage (fatty dystrophy, necroses, hemorrhages), cardiac metabolic damage, and disseminated intravascular coagulation.
Conclusions:
- Morphological changes in uteroplacental arteries are crucial for diagnosing preeclampsia/eclampsia.
- Recognizing atypical presentations and associated organ damage is vital for accurate diagnosis and management.
Abstract:
Preeclampsia is the most menacing complication of pregnancy and childbirth worldwide and remains one of the leading causes of maternal and perinatal morbidity and mortality. It is characterized by a complex etiopathogenesis with specific clinical and laboratory changes (hypertension, proteinuria and edema), as well as by the morphological pattern of target organ damage and uteroplacental blood vascular lesions. However, the triad of clinical signs of preeclampsia is not encountered in all cases now.
Objective:
to study the clinical and anatomical aspects of preeclampsia at the present stage.
Material And Methods:
17 maternal deaths due to preeclampsia were studied at the medical institutions of the Moscow Healthcare Department from 2012 to the first half of 2017 through postmortem examination at City Clinical Hospital Thirty-One, Moscow Healthcare Department.
Results:
This analysis showed the atypical course of preeclampsia (without substantial blood pressure elevations, with mild/moderate proteinuria, but almost always with edema). The characteristic feature is a laboratory sign, such as thrombocytopenia and liver enzyme dysfunction. Morphological examination of deceased patients showed that almost half of the cases had brain hemorrhages of different localization and size; in most cases, renal changes corresponded to the pattern of a shock kidney with endotheliosis and frequently with cortical necroses. The liver was characterized by a considerable increase in size with the development of fatty dystrophy, centrolobular necroses and hemorrhages; there were metabolic damage foci in the heart in almost half of the cases, as well as signs of disseminated intravascular coagulation with numerous hemorrhages in the organs and tissues.
Conclusion:
Characteristic uteroplacental artery morphological changes in both the surgical and autopsy material render a leading assistance in the diagnosis of preeclampsia/eclampsia.
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