Complicaciones De Preeclampsia: Actualización

[Preeclampsia Complications: Update]
DOI: 10.37980/im.journal.revcog.20221925
Publicado
2022-08-24

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Autores/as

  • Jorge Arturo Collantes Cubas Docente invitado de la Universidad Nacional de Cajamarca, Hospital Regional Docente de Cajamarca, Perú; RENACYT, Perú
  • Edwub Román Guzmán Aybar 1- Docente invitado de la Universidad Nacional de Cajamarca, Hospital Regional Docente de Cajamarca, Perú
  • Paulino Vigil-De Gracia Complejo Hospitalario Dr. AAM, Caja de Seguro Social; SNI, SENACYT, Panamá

Palabras clave:

eclampsia, edema pulmonar, injuria renal aguda, Síndrome HELLP, ruptura hepática, restricción del crecimiento intrauterino

Keywords:

eclampsia, pulmonary edema, acute kidney injury, HELLP syndrome, hepatic rupture, fetal growth restriction

Resumen

En esta actualización se definen las complicaciones de pre-eclampsia empezando por los cambios en la definición que incluyen 6 órganos blanco incluyendo el edema pulmonar y el compromiso utero-placentario.

En eclampsia se precisa su fisiopatología como perdida de autorregulación del flujo sanguíneo cerebral, edema y posible hemorragia, se presentan los esquemas de sulfato de magnesio y se define su no probada necesidad en el postparto.

En edema pulmonar se contemplan las 3 causas como presión incrementada, sobre-hidratación y daño endotelial precisando en el manejo a veces los diuréticos y a veces la intubación.

En ruptura hepática, se precisa su etiología que inicia con daño endotelial extravasación de glóbulos rojos, trombosis, hemorragia, formación de hematoma y su ruptura. Se precisa los segmentos del lóbulo derecho como los mayormente comprometidos, la precisión del grado de daño hepático con dos clasificaciones y sus múltiples manejos basados en el empaquetamiento hepático.

En síndrome HELLP, se precisa su etiología como la suma del compromiso hepático y hematológico, la necesidad de precisar los grados de severidad y se muestra que su presencia más de origen temprano agrava las demás complicaciones. Se menciona los beneficios de la dexametasona en su manejo.

En Injuria renal aguda se muestra en la etiología no sólo la glomeruloendoteliosis si no la podocituria y la trombosis microangiopática, se precisa la presencia de hematuria como signo de alarma, los criterios de los estadios AKI 1, 2 y 3 de la última clasificación y su manejo con terapia de reemplazo y hemodiálisis.

Por último, en el compromiso útero placentario, se precisan las últimas definiciones de RCIU que es un dato de severidad de pre-eclampsia y que tomar en cuenta el criterio previene la mortalidad perinatal significativamente que cuando no se considera como criterio.


Abstract

This update defines complications of preeclampsia starting with changes in definition that include 6 target organs including pulmonary edema and Uteroplacental dysfunction.

In eclampsia its pathophysiology is specified as a loss of self-regulation of cerebral blood flow, edema and possible hemorrhage, magnesium sulfate schemes are presented and its unproven need in the postpartum period is defined.

In acute pulmonary edema, the 3 causes are contemplated such as increased pressure, overhydration and endothelial damage, sometimes requiring diuretics and sometimes intubation in the management.

In hepatic rupture, its etiology is specified that begins with extravasation endothelial damage of red blood cells, thrombosis, hemorrhage, hematoma formation and its rupture. It specifies the segments of the right lobe as the most compromised, the accuracy of the degree of liver damage with two classifications and its multiple management based on liver packing.

In HELLP syndrome, its etiology is specified as the sum of the hepatic and hematological involvement, the need to specify the degrees of severity and it is shown that its presence more of early origin aggravates the other complications. The benefits of dexamethasone in its management are mentioned.

In acute kidney injury, the etiology shows not only glomeruloendotheliosis but also podocituria and microangiopathic thrombosis, the presence of hematuria as a sign of alarm, the criteria of the AKI stages 1, 2 and 3 of the last classification and its management with replacement therapy and hemodialysis.

Finally, in placental uterine involvement, the latest definitions of o fetal growth restriction are specified, which is a data of severity of preeclampsia and that taking into account the criterion prevents perinatal mortality significantly than when it is not considered as a criterion.

Citas

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