Pathophysiology of Pre-Eclampsia and Eclampsia: “Bridging Mechanisms to Outcomes” (Tracing the Roots, Understanding the Impact)


Authors : Karra Geetha; B. Shree Bhavana; Satya Jahnavi P; Orugala Amulya; T. Rama Rao

Volume/Issue : Volume 10 - 2025, Issue 2 - February


Google Scholar : https://tinyurl.com/yr67mts6

Scribd : https://tinyurl.com/bdf75fy2

DOI : https://doi.org/10.5281/zenodo.14899170


Abstract : Preeclampsia and eclampsia are severe pregnancy complications recognized by hypertension, proteinuria and organ failure. Prompt diagnosis and management reduce the risk of complications of the mother and foetus. Soluble fms- like tyrosine kinase 1, soluble endoglinand angiogenic factors are important biochemical indicators of disease progression. Increased soluble fms-like tyrosine kinase 1 and decreased levels of placental growth factor(PIGF) are related to endothelial injury, which explains the causal association to these events, but markers linked to endothelial dysfunction such as platelet activation and placentation such as pregnancy-associated plasma protein A can be utilized for early diagnosis and follow- up in women with preeclampsia. Excess of uric acid pushes the condition to progress. Methods like doppler ultrasonography helps a lot in assessing uterine artery resistance and predicting the development of Preeclampsia. The condition puts mothers at risk for seizures, stroke, organ failure and heamolysis, elevated liver enzymes, low platelet count(HELLP) syndrome, while kids can face problems like restricted development, early delivery, and low oxygen availability. Patients with preeclampsia receive treatment through blood pressure maintenance along with seizure prevention requiring administration of magnesium sulphate. If hypertension becomes severe medical staff treat it with either labetalol or hydralazine or nifedipine or with magnesium sulphate (for seizures). Severe hypertension may be treated with other medications including labetalol, hydralazine, or nifedipine. Preventive measures through low-dose aspirin and calcium supplements hold hope predominantly for groups at lower disease risks while early detection plus proper monitoring and management lead to successful maternal and foetal outcomes. The significance of developing advanced analytical approaches along with preventive practices stands out as fundamental to minimize difficulties which emerge from high-risk maternal situations.

Keywords : Preeclampsia, Eclampsia, Endothelial Dysfunction, Doppler ultrasonography, Hypertension, Proteinuria, Seizures.

References :

  1. Gupte S, Wagh G. Preeclampsia-eclampsia. J Obstet Gynaecol India. 2014 Feb;64(1):4-13. doi: 10.1007/s13224-014-0502-y. Epub 2014 Jan 31. PMID: 24587599; PMCID: PMC3931898.
  2. Rana S, Lemoine E, Granger J, Karumanchi SA. Preeclampsia: Pathophysiology, challenges, and perspectives. Circulation Research. 2019 Mar 29;124(7):1094–112.
  3. Erez, O., Romero, R., Jung, E., Chaemsaithong, P., Bosco, M., Suksai, M., Gallo, D. M., & Gotsch, F. (2022). Preeclampsia and eclampsia: the conceptual evolution of a syndrome. American journal of obstetrics and gynecology, 226(2S), S786–S803. https://doi.org/10.1016/j.ajog.2021.12.001
  4. Redman, C. W., & Sargent, I. L. (2005). Latest advances in understanding preeclampsia. Science (New York, N.Y.), 308(5728), 1592–1594. https://doi.org/10.1126/science.1111726
  5. Warrington JP, George EM, Palei AC, Spradley FT, Granger JP. Recent Advances in the Understanding of the Pathophysiology of Preeclampsia. Hypertension. 2013 Oct;62(4):666–73.
  6. Myatt, L., & Webster, R. P. (2009). Vascular biology of preeclampsia. Journal of Thrombosis and Haemostasis, 7(3), 375-384. doi: 10.1111/j.1538-7836.2009.03304.x
  7. Redman, C.W., Sargent, I.L., & Staff, A.C. (2021). "Review: The pathogenesis of pre-eclampsia: Development and function of the placenta." Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 25, 100-107. [https://doi.org/10.1016/j.preghy.2021.07.001]
  8. Williams A, Khan MA, Moniruzzaman M, Rahaman ST, Mannan II, de Graft-Johnson J, Rashid I, Rawlins B. Management of Preeclampsia, Severe Preeclampsia, and Eclampsia at Primary Care Facilities in Bangladesh. Glob Health Sci Pract. 2019 Sep 26;7(3):457-468. doi: 10.9745/GHSP-D-19-00124. PMID: 31527058; PMCID: PMC6816814.
  9. Gamliel M, Goldman-Wohl D, Isaacson B, Gur C, Stein N, Yamin R, et al. Trained Memory of Human Uterine NK Cells Enhances Their Function in Subsequent Pregnancies. Immunity. 2018 May 15 [cited 2023 Apr 2];48(5):951-962.e5. Available from: https://pubmed.ncbi.nlm.nih.gov/29768178/
  10. Pate AT, Schnell AL, Ennis TA, Samson WK, Gina. Expression and function of nesfatin-1 are altered by stage of the estrous cycle. AJP Regulatory Integrative and Comparative Physiology. 2019 May 29;317(2):R328–36.
  11. Lee CL, Jan H.W. Veerbeek, Rana TK, Rijn van, Burton GJ, Hong Wa Yung. Role of Endoplasmic Reticulum Stress in Proinflammatory Cytokine–Mediated Inhibition of Trophoblast Invasion in Placenta-Related Complications of Pregnancy. 2019 Feb 1;189(2):467–78.
  12. Ward K, Hannele Laivuori, Taylor RN. Genetic Factors in the Etiology of Preeclampsia/Eclampsia. Elsevier eBooks. 2022 Jan 1;(Version of Record 14 January 2022.):45–69.
  13. Williams PJ, Broughton Pipkin F. The genetics of pre-eclampsia and other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011 Aug;25(4):405-17. doi: 10.1016/j.bpobgyn.2011.02.007. Epub 2011 Mar 22. PMID: 21429808; PMCID: PMC3145161.
  14. Tiirikainen M, Nityanand A. Understanding the Genetic Origins of Preeclampsia -. LifeDNA. 2024 [cited 2025 Jan 23]. Available from: https://blog.lifedna.com/dna-blog/understanding-the-genetic-origins-of-preeclampsia/
  15. Tyrmi, J. S., Kaartokallio, T., Lokki, A. I., Jääskeläinen, T., Kortelainen, E., Ruotsalainen, S., Karjalainen, J., Ripatti, S., Kivioja, A., Laisk, T., Kettunen, J., Pouta, A., Kivinen, K., Kajantie, E., Heinonen, S., Kere, J., Laivuori, H., & FINNPEC Study Group, FinnGen Project, and the Estonian Biobank Research Team (2023). Genetic Risk Factors Associated With Preeclampsia and Hypertensive Disorders of Pregnancy. JAMA cardiology8(7), 674–683. https://doi.org/10.1001/jamacardio.2023.1312
  16. Magley M, Hinson MR. Eclampsia. [Updated 2024 Oct 6]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554392/
  17. Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019 Jul 15;366(366):l2381. Available from: https://www.bmj.com/content/366/bmj.l2381
  18. Ives CW, Sinkey R, Rajapreyar I, Tita ATN, Oparil S. Preeclampsia—Pathophysiology and Clinical Presentations: JACC State-of-the-Art Review. Journal of the American College of Cardiology. 2020 Oct 6;76(14):1690–702.
  19. Wikipedia Contributors. Eclampsia Wikipedia. Wikimedia Foundation; 2025.
    Available from:
    https://en.wikipedia.org/wiki/Eclampsia?utm_source
  20. Janzarik WG, Ehlers E, Ehmann R, Gerds TA, Schork J, Mayer S, et al. Dynamic Cerebral Autoregulation in Pregnancy and the Risk of Preeclampsia. Hypertension. 2014 Jan;63(1):161–6.
  21. Maeda KJ, McClung DM, Showmaker KC, Warrington JP, Ryan MJ, Garrett MR, et al. Endothelial cell disruption drives increased blood-brain barrier permeability and cerebral edema in the Dahl SS/jr rat model of superimposed preeclampsia. AJP Heart and Circulatory Physiology. 2020 Dec 4;320(2):H535–48.
  22. Xiaojuan Liu, Laura A. Graham, Bocheng Jing, Chintan V. Dave,  Antihypertensive Deprescribing and Functional Status in VA Long‐Term Care Residents With and Without Dementia , Journal of the American Geriatrics Society, (2025).https://doi.org/10.1111/jgs.19342
  23. Hermes Sandoval, Belén Ibáñez, Moisés Contreras, Felipe Troncoso, Fidel O. Castro, Extracellular Vesicles From Preeclampsia Disrupt the Blood-Brain Barrier by Reducing CLDN5, Arteriosclerosis, Thrombosis, and Vascular Biology, 45, 2, (298-311), (2024)./doi/10.1161/ATVBAHA.124.321077
  24. Cipolla MJ, Kraig RP. Seizures in Women with Preeclampsia: Mechanisms and Management. Fetal Matern Med Rev. 2011 May;22(2):91-108. doi: 10.1017/S0965539511000040. PMID: 21709815; PMCID: PMC3119563.
  25. Johnson, Abbie Chapman, "Mechanisms of Seizure during Pregnancy and Preeclampsia" (2015). Graduate College Dissertations and Theses. 336. https://scholarworks.uvm.edu/graddis/336
  26. Miller EC. Preeclampsia and Cerebrovascular Disease. Hypertension. 2019 Jul;74(1):5-13. doi: 10.1161/HYPERTENSIONAHA.118.11513. Epub 2019 May 6. PMID: 31055951; PMCID: PMC6636840.
  27. Anna Szyndler, Przemysław Adamski, Kamil Kowalczyk, Dariusz Gąsecki, Cerebrovascular Disease in Preeclampsia, Hypertension and Brain Damage, (253-272), (2024).https://doi.org/10.1007/978-3-031-64928-8_17
  28. J Neurocrit Care. Cerebrovascular complications during pregnancy and postpartum 2019;12 (1): 20-29. 2019 June 25 doi:https://doi.org/10.18700/jnc.190087.
  29. Vasiliki Katsi, Asimenia Svigkou, Ioanna Dima, Konstantinos Tsioufis, Diagnosis and Treatment of Eclampsia, Journal of Cardiovascular Development and Disease, 11, 9, (257), (2024).https://doi.org/10.3390/jcdd11090257
  30. Younes ST, Ryan MJ. Pathophysiology of Cerebral Vascular Dysfunction in Pregnancy-Induced Hypertension. Curr Hypertens Rep. 2019 May 23;21(7):52. doi: 10.1007/s11906-019-0961-8. PMID: 31123841; PMCID: PMC6533227.
  31. Dulay AT. Preeclampsia and Eclampsia. Merck Manual Professional Edition. Merck Manuals; 2024. Available from: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/preeclampsia-and eclampsia?utm_source=chatgpt.com
  32. Abalos E, Cuesta C, Grosso AL, Chou D, Say L: Global and regional estimates of preeclampsia and eclampsia: a systematic review. Eur J Obstet Gynecol Reprod Biol 170(1):1-7, 2013. doi:10.1016/j.ejogrb.2013.05.005
  33. Vaught AJ, Kovell LC, Szymanski LM, Mayer SA, Seifert SM, Vaidya D, et al. Acute Cardiac Effects of Severe Pre-Eclampsia. Journal of the American College of Cardiology. 2018 Jul;72(1):1–11. Available from: http://www.onlinejacc.org/content/72/1/1.
  34. Sibai BM, Mabie BC, Harvey CJ, Gonzalez AR. Pulmonary edema in severe preeclampsia-eclampsia: Analysis of thirty-seven consecutive cases. American Journal of Obstetrics & Gynecology. 2025 [cited 2025 Jan 26];156(5):1174–9. Available from: https://www.ajog.org/article/0002-9378(87)90135-9/abstract
  35. Dengjun Liu, Qian Gao, Yibin Wang, Tao Xiong, Placental dysfunction: The core mechanism for poor neurodevelopmental outcomes in the offspring of preeclampsia pregnancies, Placenta, Volume 126, 2022, Pages 224-232,ISSN 0143-4004, https://doi.org/10.1016/j.placenta.2022.07.014.
  36. Fishel Bartal M, Sibai BM. Eclampsia in the 21st century. American Journal of Obstetrics and Gynecology. 2020 Sep 24;226(2). Available from: https://www.sciencedirect.com/science/article/pii/S0002937820311285.
  37. Escudero C, Kupka E, Ibañez B, Sandoval H, Troncoso F, Anna-Karin Wikström, et al. Brain Vascular Dysfunction in Mothers and Their Children Exposed to Preeclampsia. AHA/ASA journals. 2023 Feb 1;80(2):242–56.
  38. Triplett JD, Kutlubaev MA, Kermode AG, et al Posterior reversible encephalopathy syndrome (PRES): diagnosis and management  Practical Neurology 2022;22:183-189
  39. Ambad RS, Nandkishor Bankar, Bhatt N, Shrivastava D. To Study the Clinico-Hematological Profile of Pre-Eclampsia on Mother and Newborns. Research Journal of Pharmacy and Technology. 2021 Oct 31;14(10):5527–30.
  40. Sławek-Szmyt S, Kawka-Paciorkowska K, Ciepłucha A, Lesiak M, Ropacka-Lesiak M. Preeclampsia and Fetal Growth Restriction as Risk Factors of Future Maternal Cardiovascular Disease-A Review. J Clin Med. 2022 Oct 13;11(20):6048. doi: 10.3390/jcm11206048. PMID: 36294369; PMCID: PMC9605579.
  41. Davies EL, Bell JS, Bhattacharya S. Preeclampsia and preterm delivery: A population-based case-control study. Hypertens Pregnancy. 2016 Nov;35(4):510-519. doi: 10.1080/10641955.2016.1190846. Epub 2016 Jun 20. PMID: 27322489.
  42. Parker SE, Werler MM, Gissler M, Tikkanen M, Ananth CV. Placental abruption and subsequent risk of pre-eclampsia: a population-based case-control study. Paediatr Perinat Epidemiol. 2015 May;29(3):211-9. doi: 10.1111/ppe.12184. Epub 2015 Mar 11. PMID: 25761509; PMCID: PMC4400232.
  43. Sharma DD, Chandresh NR, Javed A, Girgis P, Zeeshan M, Fatima SS, Arab TT, Gopidasan S, Daddala VC, Vaghasiya KV, Soofia A, Mylavarapu M. The Management of Preeclampsia: A Comprehensive Review of Current Practices and Future Directions. Cureus. 2024 Jan 2;16(1):e51512. doi: 10.7759/cureus.51512. PMID: 38304688; PMCID: PMC10832549.
  44. S Kanagasabai. Biochemical Markers In The Prediction Of Pre-Eclampsia, Are We There Yet?. The Internet Journal of Gynecology and Obstetrics. 2009 Volume 14 Number 1.
  45. Grill, S., Rusterholz, C., Zanetti-Dällenbach, R. et al. Potential markers of preeclampsia – a review. Reprod Biol Endocrinol 7, 70 (2009). https://doi.org/10.1186/1477-7827-7-70
  46. Petla, Lakshmi Tanuja; Chikkala, Rosy; Ratnakar, K.S.*; Kodati, Vijayalakshmi**; Sritharan, V.. Biomarkers for the management of pre-eclampsia in pregnant women. The Indian Journal of Medical Research 138(1):p 60-67, July 2013.
  47. Renad Marwan Alghifari, Nuwayir Ibrahim Alhusayni, Zahrah Fuad Alyamani, Aliaa Sabban, Yousef Almoghrabi, Khalid Hussein Bakheit. The Role of Biochemical Markers in the Prediction of Preeclampsia. International Journal of Biochemistry Research & Review. 2023 Nov 2;32(8):39–47.
  48. Zhong Y, Tuuli M, Odibo AO. First-trimester assessment of placenta function and the prediction of preeclampsia and intrauterine growth restriction. Prenatal Diagnosis. 2010;n/a-n/a.
  49. Katsi V, Asimenia Svigkou, Dima I, Konstantinos Tsioufis. Diagnosis and Treatment of Eclampsia. Journal of Cardiovascular Development and Disease. 2024 Aug 23;11(9):257–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11432638/
  50. Qi, J., Wu, B., Chen, X. et al. Diagnostic biomolecules and combination therapy for pre-eclampsia. Reprod Biol Endocrinol 20, 136 (2022). https://doi.org/10.1186/s12958-022-01003-3.

Preeclampsia and eclampsia are severe pregnancy complications recognized by hypertension, proteinuria and organ failure. Prompt diagnosis and management reduce the risk of complications of the mother and foetus. Soluble fms- like tyrosine kinase 1, soluble endoglinand angiogenic factors are important biochemical indicators of disease progression. Increased soluble fms-like tyrosine kinase 1 and decreased levels of placental growth factor(PIGF) are related to endothelial injury, which explains the causal association to these events, but markers linked to endothelial dysfunction such as platelet activation and placentation such as pregnancy-associated plasma protein A can be utilized for early diagnosis and follow- up in women with preeclampsia. Excess of uric acid pushes the condition to progress. Methods like doppler ultrasonography helps a lot in assessing uterine artery resistance and predicting the development of Preeclampsia. The condition puts mothers at risk for seizures, stroke, organ failure and heamolysis, elevated liver enzymes, low platelet count(HELLP) syndrome, while kids can face problems like restricted development, early delivery, and low oxygen availability. Patients with preeclampsia receive treatment through blood pressure maintenance along with seizure prevention requiring administration of magnesium sulphate. If hypertension becomes severe medical staff treat it with either labetalol or hydralazine or nifedipine or with magnesium sulphate (for seizures). Severe hypertension may be treated with other medications including labetalol, hydralazine, or nifedipine. Preventive measures through low-dose aspirin and calcium supplements hold hope predominantly for groups at lower disease risks while early detection plus proper monitoring and management lead to successful maternal and foetal outcomes. The significance of developing advanced analytical approaches along with preventive practices stands out as fundamental to minimize difficulties which emerge from high-risk maternal situations.

Keywords : Preeclampsia, Eclampsia, Endothelial Dysfunction, Doppler ultrasonography, Hypertension, Proteinuria, Seizures.

Never miss an update from Papermashup

Get notified about the latest tutorials and downloads.

Subscribe by Email

Get alerts directly into your inbox after each post and stay updated.
Subscribe
OR

Subscribe by RSS

Add our RSS to your feedreader to get regular updates from us.
Subscribe