••• Chapter 13^ Hypertension and Pregnancy^119
❍ How does the prostacyclin: thromboxane angiotensin 2 ratio change in preeclampsia?
It decreases; thus, there is increased sensitivity to infused angiotensin 2, which results in vasoconstriction.
❍ What is the effect of gestational hypertension on blood volume during pregnancy?
In average size women, there is an expected increase in the blood volume at the end of normal pregnancy from
3500 to 5000 mL. With gestational hypertension, a normal blood volume is expected.
❍ What is the effect of preeclampsia on blood volume during pregnancy?
Different degrees of hemoconcentration are expected with preeclampsia depending on the severity.
❍ What is the effect of eclampsia on blood volume during pregnancy?
Absence of much or all of the anticipated volume excess is expected with eclampsia.
❍ What renal changes are associated with preeclampsia during pregnancy?
As a result of vasospasm, the normal expected increase in glomerular filtration rate and renal blood flow and the
expected decrease in serum creatinine may not occur in women with preeclampsia, especially if the disease is severe.
❍ Why does oliguria occur in preeclampsia?
Oliguria is secondary to the hemoconcentration and decreased renal blood flow. Rarely, persistent oliguria may
reflect acute tubular necrosis, which may lead to acute renal failure.
❍ What is the characteristic hepatic lesion associated with gestational hypertension?
Periportal hemorrhage in the liver periphery.
❍ What clinical manifestations can be associated with preeclampsia?
- Vascular hypertension
- Hemoconcentration
- Intense vasospasm
- Hematologic thrombocytopenia
- Hemolysis
- Hepatic elevated aspartate aminotransferase (AST) and alanine transaminase (ALT)
- Hyperbilirubinemia
- Hepatic hemorrhage
- Neurologic temporary blindness
- Headache
- Blurred vision
- Scotomata
- Hyper-reflexia
- Eclampsia
- Renal oliguria
- ATN
- Absence of decrease in serum creatinine
- Fetal intrauterine growth restriction (IUGR)
- Oligohydramnios
- Placental abruption
- Nonreassuring fetal status