PRE-ECLAMPSIA

Pregnancy is a transformative journey for any woman, but sometimes, it comes with unexpected challenges. One such challenge is pre-eclampsia, a condition that affects expectant mothers, posing risks to both mother and child.

Preeclampsia, previously known as toxemia, occurs during pregnancy when there’s high blood pressure, excess protein in urine, and swelling in the legs, feet, and hands. Its severity can vary from mild to severe, typically occurring later in pregnancy but may also manifest earlier or shortly after childbirth.

The only definitive treatment for preeclampsia is childbirth. However, even after delivery, symptoms may persist for six weeks or longer.

Being aware of preeclampsia symptoms and attending regular prenatal check-ups can aid in early detection, potentially reducing the risk of long-term complications for both the mother and baby.

Understanding Postpartum Preeclampsia

Postpartum preeclampsia is a rare condition characterized by high blood pressure and excess protein in urine following childbirth. It commonly occurs within 48 hours after delivery but can also arise six weeks or later afterward, termed as late postpartum preeclampsia.

Immediate medical attention is essential for postpartum preeclampsia as it can lead to seizures or other severe complications if left untreated.

Preeclampsia and Eclampsia

Preeclampsia can progress to eclampsia, a serious condition posing health risks for both mother and baby and, in rare instances, leading to fatalities. Eclampsia occurs when preeclampsia culminates in seizures.

Causes of Pre-eclampsia

Pre-eclampsia’s precise cause remains elusive, but it’s believed to originate from abnormal placental development early in pregnancy. This abnormal development leads to poor blood supply to the placenta, triggering the release of certain proteins into the mother’s bloodstream, causing blood vessels to constrict and leading to high blood pressure.Reduced blood flow to the uterus might contribute to the condition, alongside genetic factors.

How Rapidly Does Preeclampsia Develop?

can emerge as early as the 20th week of pregnancy, although this occurrence is uncommon. Symptoms typically commence after the 34th week. In some instances, symptoms manifest post-delivery, usually within 48 hours. It’s crucial to note that preeclampsia can occur without presenting any symptoms.

Prevalence

Pre-eclampsia affects around 5-8% of pregnancies worldwide, making it a significant concern in maternal health.

Other Pregnancy-Related High Blood Pressure Disorders

Preeclampsia is one of four high blood pressure disorders that can arise during pregnancy:

Gestational hypertension: High blood pressure occurring after the 20th week of pregnancy without significant protein in urine. It typically resolves after childbirth.
Chronic hypertension: High blood pressure present before pregnancy or before the 20th week of gestation.
Chronic hypertension with superimposed preeclampsia: Chronic high blood pressure worsening during pregnancy, leading to increased protein in urine and additional complications.

Symptoms of Pre-eclampsia

Apart from swelling (known as edema), increased protein in urine, and blood pressure exceeding 140/90, preeclampsia symptoms encompass:

Rapid weight gain within 1 or 2 days due to a significant surge in bodily fluids.
Shoulder discomfort.
Abdominal pain, particularly on the upper right side.
Intense headaches.
Alterations in reflexes or mental state.
Decreased or absent urination.
Dizziness.
Breathing difficulties.
Severe nausea and vomiting.
Visual changes such as flashing lights, floaters, or blurred vision.

However, it’s possible to have preeclampsia without exhibiting any symptoms. Hence, regular check-ups with your doctor for blood pressure monitoring and urine tests are essential.

High Blood Pressure and Preeclampsia

Uncontrolled high blood pressure during pregnancy can lead to serious complications for both you and your baby. High blood pressure might precede pregnancy or arise for the first time during gestation. Preeclampsia represents a severe form of high blood pressure that can occur during pregnancy or shortly after delivery.

Risk Factors of Pre-eclampsia

Certain factors elevate the risk of developing preeclampsia:

High-Risk Factors:

History of preeclampsia.
Carrying multiple babies (twins, triplets, etc.).
Chronic hypertension.
Kidney disease.
Diabetes.
Autoimmune conditions like lupus.
Presence of multiple moderate-risk factors.

Moderate-Risk Factors:

First pregnancy.
Pregnancy occurring more than 10 years after the last one.
BMI exceeding 30.
Family history of preeclampsia (e.g., mother or sister experiencing it).
Age 35 or older.
Previous pregnancy complications such as delivering a low birth weight baby.
Undergoing in vitro fertilization (IVF).
Being Black (due to disparities increasing the risk of illness).
Lower income status (due to disparities increasing the risk of illness).

Is Preeclampsia a Medical Emergency?

Dealing with preeclampsia demands serious attention from your healthcare provider. They’ll closely monitor and manage your condition. However, if preeclampsia progresses to eclampsia, marked by seizures, or if severe complications arise, it becomes a medical emergency. Urgent treatment, usually administered in a hospital setting, is crucial to alleviate symptoms and ensure the safe delivery of your baby.

Diagnosing Preeclampsia

Preeclampsia is diagnosed when high blood pressure is accompanied by at least one of the following indicators:

Elevated protein levels in urine
Insufficient platelets in the blood
Elevated levels of kidney-related chemicals in the blood
Elevated levels of liver-related chemicals in the blood
Fluid accumulation in the lungs
Persistent, unrelieved headaches despite medication

To confirm the diagnosis, your healthcare provider may conduct various tests, including:

Blood tests to assess platelet count and levels of kidney or liver chemicals
Urine tests to measure protein levels
Ultrasounds, nonstress tests, or biophysical profiles to monitor the growth and well-being of your baby

Treatments for Pre-eclampsia

The definitive solution for preeclampsia and eclampsia is childbirth. Your doctor will discuss the timing of delivery based on your baby’s gestational age, their well-being in the womb, and the severity of your preeclampsia.

If your baby has reached a healthy stage, typically 37 weeks or beyond, your doctor may recommend inducing labor or performing a cesarean section. This proactive approach helps prevent the worsening of preeclampsia.

When your baby isn’t nearing full term, you and your doctor might opt to manage mild preeclampsia until it’s safe to deliver. The closer the delivery aligns with your due date, the better it is for your baby’s health.

For cases of mild preeclampsia, also known as preeclampsia without severe features, your doctor may advise:

Resting, either at home or in the hospital, primarily on your left side
Close monitoring with fetal heart rate monitoring and frequent ultrasounds
Prescription medications to regulate blood pressure
Regular blood and urine tests

In some instances, hospitalization may be necessary for close observation. During hospital stays, treatments may include:

Medications to prevent seizures, lower blood pressure, and mitigate other complications
Steroid injections to accelerate the development of your baby’s lungs

Additional treatments might involve:

Magnesium injections to prevent eclampsia-related seizures
Administration of hydralazine or other blood pressure medications

In cases of severe preeclampsia, prompt delivery may be imperative, regardless of gestational age. Following delivery, preeclampsia symptoms typically subside within 1 to 6 weeks, although they may persist for a longer duration.

Home Care Tips

While under medical supervision, expectant mothers can take certain measures at home to manage pre-eclampsia, such as monitoring blood pressure regularly, resting in a left lateral position to improve blood flow to the uterus, reducing salt intake, staying hydrated, and attending all prenatal appointments.

Can babies survive if the mother has preeclampsia?

Most babies born to mothers with preeclampsia are healthy. However, untreated preeclampsia can lead to severe health issues for both mother and baby.

Complications of Preeclampsia

Preeclampsia can impede the placenta’s blood supply, resulting in fetal growth restriction, where the baby is born significantly underweight. This condition is known as fetal growth restriction.

Furthermore, it stands as one of the primary causes of premature births and subsequent complications such as learning disabilities, epilepsy, cerebral palsy, and sensory impairments.

Preeclampsia may lead to rare yet severe complications, including:

Eclampsia: Characterized by seizures or coma accompanied by preeclampsia symptoms. It’s challenging to predict if preeclampsia will progress to eclampsia, and seizures can occur without prior warning signs. Symptoms preceding seizures may include intense headaches, vision disturbances, mental confusion, and altered behavior. Eclampsia can arise before, during, or after childbirth.
Preterm Birth: Delivery occurring before 37 weeks, increasing the risk of respiratory and feeding difficulties, sensory impairments, developmental delays, and cerebral palsy in the newborn. Interventions before preterm delivery may mitigate some risks.
Stroke
Seizure
Fluid accumulation in the chest
Reversible blindness
Liver bleeding
Postpartum bleeding
Organ Damage: Preeclampsia can harm the kidneys, liver, lungs, heart, and eyes, potentially leading to stroke or other brain injuries. The extent of organ damage correlates with the severity of preeclampsia.
Cardiovascular Disease: Preeclampsia increases the risk of future cardiovascular diseases, particularly if it recurs or if there’s a history of preterm delivery.

When preeclampsia or eclampsia compromises liver and blood cell function, it can result in a condition known as HELLP syndrome, characterized by:

Hemolysis: Breakdown of red blood cells responsible for oxygen transport.
Elevated liver enzymes: High levels indicating liver dysfunction.
Low platelet counts: Insufficient platelets impairing blood clotting.

HELLP syndrome necessitates immediate medical attention. Seek emergency care if experiencing symptoms like blurry vision, chest or abdominal pain, headaches, fatigue, nausea, vomiting, facial or hand swelling, or bleeding from the gums or nose.

Additionally, preeclampsia can precipitate sudden separation of the placenta from the uterus, termed placental abruption, which may lead to stillbirth.

Prevention

For those at increased risk of preeclampsia, a daily low-dose aspirin (81 milligrams) might be recommended by your doctor. However, always consult with them before taking any medications, vitamins, or supplements.

Additionally, discuss lifestyle adjustments with your doctor to promote overall health and potentially reduce the risk of preeclampsia. This might include:

Maintaining a healthy weight before pregnancy
Quitting smoking and excessive alcohol consumption during pregnancy
attending regular prenatal check-ups
Regular exercise
Managing pre-existing conditions like blood pressure or blood sugar levels

When to See a Doctor

Expectant mothers should promptly report any unusual symptoms to their healthcare provider, including sudden swelling, persistent headaches, visual disturbances, or abdominal pain, as these could indicate pre-eclampsia or other pregnancy complications.

Outlook/Prognosis

With timely diagnosis and proper management, many women with pre-eclampsia go on to have healthy pregnancies and deliveries. However, untreated pre-eclampsia can lead to serious complications for both mother and baby, including seizures (eclampsia), organ damage, and preterm birth.

Note

Preeclampsia occurs during pregnancy and is characterized by high blood pressure, excessive protein in urine, and swelling in the legs, feet, and hands.
Formerly known as toxemia, preeclampsia typically occurs in the later stages of pregnancy but can manifest earlier or postpartum.
Preeclampsia is one of four pregnancy-related hypertensive disorders.
Without treatment, preeclampsia can lead to severe complications such as eclampsia, posing risks to both mother and baby.
Immediate medical attention is crucial if experiencing symptoms of preeclampsia.
Early delivery is often advised in cases of preeclampsia.
The only definitive treatment for preeclampsia is delivery.

Sources

American College of Obstetricians and Gynecologists. (2020). Hypertension in pregnancy.
Mayo Clinic. (2020). Preeclampsia.
March of Dimes: “Preeclampsia,” “HELLP Syndrome.”
Patients Up to Date: “Preeclampsia.”
University of Maryland: “Preeclampsia.”
MedLine Plus: “Preeclampsia.”
Preeclampsia Foundation: “Signs & Symptoms,” “What Is Superimposed Preeclampsia?” “FAQs.”
National Center for Advancing Transitional Sciences Genetic and Rare Diseases Information Center: “HELLP syndrome.”
Obstetrics & Gynecology: “ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia.”
Cleveland Clinic: “Preeclampsia.”
University of Michigan: “Preeclampsia: Creatinine Clearance Test.”
UpToDate: “Preeclampsia: Clinical features and diagnosis.”
Patients Up to Date: “Preeclampsia.”
Eunice Kennedy Shriver National Institute of Child and Human Development: “What Are the Treatments for Preeclampsia, Eclampsia, & HELLP Syndrome?”
National Institute for Health and Care Excellence. (2019). Hypertension in pregnancy: diagnosis and management.
World Health Organization. (2019). Maternal mortality.