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Preeclampsia, part 3.

The exact incidence of preeclampsia is unknown, but in its mild form it is estimated to affect up to 10% of all pregnancies. Indeed, it is one of the most common complications of pregnancy. In a smaller number of cases (just under 1% of pregnancies), the disorder develops as severe preeclampsia.

In the past two Master Class installments on preeclampsia, we have discussed how the disorder presents in various, ways, afflicting women of different age groups, of varying parity, and with associated medical complications or the lack thereof.

We have also discussed appropriate evaluation and management protocols. The spectrum of disease is such that it spans the very mild (requiring modest intervention) to the very severe (requiring immediate and aggressive intervention strategies). As we saw in the last installment, it is important to view preeclampsia as a multifaceted disease continuum in which designations of "mild" and "severe" are not necessarily fixed.

The variable presentation of the disorder--and the fact that it cannot be precisely predicted or prevented--may in itself be challenging to the practitioner, as he or she counsels patients who are contemplating pregnancies and may be at risk for preeclampsia.

There are certain predisposing medical and sociodemographic factors, however, that are clearly important and that can be useful if they are integrated in to an evaluation and management algorithm. Integrating our knowledge of risk factors allows for the most appropriate counseling to be delivered, and the most appropriate management plan to be developed, on a case-by-case basis.

I have invited Dr. Baha Sibai to once again address the topic of preeclampsia in this third and final installment of our series on the disorder. Dr. Sibai is professor of obstetrics and gynecology at the University of Cincinnati and an international expert on preeclampsia and eclampsia, as well as a leader in both clinical care and research in this area.

In this case, we've taken a different approach to presenting, the material. We think our case-by-case format will be practical and applicable to the practitioner who is counseling a number of patients who present with varying histories and risk factors.


DR. REECE, who specializes in maternal-fetal medicine, is vice president for medical affairs, University of Maryland, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. He is the medical editor of this column.
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Title Annotation:MASTER CLASS
Author:Reece, E. Albert
Publication:OB GYN News
Date:Nov 1, 2008
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