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Risk - factors
The risk factors for preeclampsia and eclampsia are: nulliparity, family history of preeclampsia, multiple
gestation, history of diabetes and hypertension, hypertension during pregnancy, rapidly growing
hydatidiform mole, mother’s age, antiphospholipid syndrome, impaired glucose tolerance, caesarean
delivery, race [6,8,21-23] . There is evidence that women who smoke are less likely to develop eclampsia,
[24]
although the reason is not clear . Almost all these risk-factors are linked to cardiovascular diseases as well
(hypertension, impaired glucose tolerance, age, inflammatory profile, race, etc.).

Systematic review and meta-analysis of cohort studies of 25,356,688 pregnancies among 92 studies out of 27
[25]
countries has shown, that the risk of development of preeclampsia is clearly linked to antiphospholipid
antibody syndrome, prior preeclampsia, chronic hypertension, pregestational diabetes, assisted reproductive
technology, and BMI > 30. These factors are strongly associated with a high rate of preeclampsia, and
presence of any of them will help to reveal the woman with “high risk” of preeclampsia.

Clinical characteristics
Patients with preeclampsia/eclampsia may develop following complaints [26,27] : headache, seizures, visual
disturbances (blurred vision, migraine - blinking scotoma), changed mental status, blindness cortical or
retinal, shortness of breath, dyspnea, edema, epigastric or pain in the upper right corner of the abdomen,
weakness, inability, may be presented signs of haemolytic anemia. It is noteworthy that eclampsia may be
developed without prodromal symptoms [28,29] .

For a long time it was considered that eclampsia follows the pregnancy, but in recent years information
about late (postpartum) eclampsia is growing, and more and more cases of late eclampsia are described
and presented. Different authors describe different frequencies of late eclampsia, although the number of
complications is not small and varies from 0.3% to 27% [30,31] . Almost half of eclampsia cases develop after
childbirth [13,32] . Seizure is predominantly developing in the first 48 hours after childbirth, although it may
occur even at 60 day .
[18]

Whether early and late preeclampsia/eclampsia have the same pathophysiological mechanisms is
not clear. Since pregnancy contains cardiovascular and metabolic stress, response to this stress may
represent a woman’s personal risk during lifespan, such serious and dangerous complication as venous
[33]
thromboembolism and pulmonary thromboembolism among others .
Late onset postpartum preeclampsia differs clinically from antepartum eclampsia. Thus study conducted
on 194 patients with eclampsia (92 antepartum and 92 postpartum) showed, that patients with postpartum
preeclampsia were older, multiparous and of lower socio-economic status than patients with antepartum
preeclampsia, additionally, patients with postpartum preeclampsia have more clinical symptoms like
headache, elevated blood pressure, abnormal vision, nausea/vomiting, seizures, shortness of breath and pedal
edema, they also show significantly higher laboratory markers, than patients with antepartum preeclampsia.
[34]
And additionally, they more often require blood pressure treatment after discharge .

It is known that eclampsia and preeclampsia increases the risk of cardiovascular morbidity at 2-4 times
in lifetime and reaches the level of risk related to tobacco consumption . In this group of population is
[3]
manifested life-long increase of incidence of arterial hypertension and metabolic disorders. Thus, after two
years of observation of women with preeclampsia and eclampsia had been shown the increase the risk of
[11]
cardiovascular disease ; Hypertension during pregnancy is associated with rise of 10 year cardiovascular
risk in women , women with preeclampsia who remain having hypertension after delivery have a twofold
[35]
[36]
[37]
rise of risk of developing CVD in the next 10-30 years , particularly during their fifth decade . That’s why