Pre-eclampsia history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Diagnosis
=History and Symptoms
- According to the new guideline of ISSHP 2018, every hypertensive pregnant woman after 20 weeks, should be evaluated for preeclampsia by investigation about multiple organ involvement, even in the absence of proteinuria.
According to the concept proposed by the International Society for Studies in Gestational Hypertension, published in 2014 and reinforced in 2018 [24], every hypertensive pregnant woman should be investigated for multiple organ involvement, even if presenting negative proteinuria, in order to discard the hypothesis of preeclampsia. This approach is innovative and tends more broadly to encompass cases that are somewhat neglected by the absence of proteinuria
Pre-eclampsia is usually asymptomatic, hence its detection depends on signs or investigations. Nonetheless, one symptom is crucially important because it is so often misinterpreted. The epigastric pain, which reflects hepatic involvement and is typical of the HELLP syndrome, may easily be confused with heartburn, a very common problem of pregnancy. However, it is not burning in quality, does not spread upwards towards the throat, is associated with hepatic tenderness, may radiate through to the back, and is not relieved by giving antacids. It is often very severe, described by sufferers as the worst pain that they have ever experienced. Affected women are not uncommonly referred to general surgeons as suffering from an acute abdomen, for example acute cholecystitis.
In general, none of the signs of pre-eclampsia is specific; even convulsions in pregnancy are more likely to have causes other than eclampsia in modern practice. Diagnosis, therefore, depends on finding a coincidence of several pre-eclamptic features, the final proof being their regression after delivery.