PREECLAMPSIA

Preeclampsia, previously called Toxemia, is a complication in pregnancy identified by increased blood pressure and signs of damage to another organ system. The most affected organs are the liver and kidneys. Preeclampsia can range from mild to severe. Preeclampsia can occur as early as 20 weeks of pregnancy, but that’s rare. Symptoms often begin after 34 weeks. On rare occasions, symptoms show after birth, usually within 48 hours of childbirth. If left untreated it can lead to serious complications for both mother and child. The most effective treatment is the delivery of the baby.

Causes of Preeclampsia

The exact cause of preeclampsia involves several factors which begin in the placenta. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta, but in women with preeclampsia, these blood vessels don’t seem to develop or function properly. They’re narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them.

Causes of this abnormal development may include:

  • Insufficient blood flow to the uterus
  • Damage to the blood vessels
  • A problem with the immune system
  • Certain genes

Risk Factors of Preeclampsia

Factors that can increase the chance of preeclampsia include:

  • History of preeclampsia: An individual with a personal or family history of preeclampsia increases the person’s risk of having it.
  • Chronic hypertension: A person that has chronic hypertension has a higher risk of developing preeclampsia.
  • First pregnancy: The risk of developing preeclampsia is highest during the first pregnancy.
  • New paternity: Each pregnancy with a new partner increases the risk of preeclampsia more than does a second or third pregnancy with the same partner.
  • Age: The risk of preeclampsia is higher for very young pregnant women as well as pregnant women older than 35.
  • Race: Black women have a higher risk of developing preeclampsia than women of other races.
  • Obesity: The risk of preeclampsia is higher for people that are obese.
  • Multiple pregnancies: Preeclampsia is more common in women who are carrying twins, triplets, or other multiples.
  • Interval between pregnancies: Having babies less than two years or more than 10 years apart leads to a higher risk of preeclampsia.
  • History of certain conditions: Having certain conditions before pregnancy such as chronic high blood pressure, migraines, type 1 or type 2 diabetes, kidney disease, or lupus increases the risk of preeclampsia.
  • In vitro fertilization: The risk of preeclampsia is increased if the baby was conceived with in vitro fertilization.

Signs and Symptoms of Preeclampsia

Some women do not experience any symptoms. So it is important to always have regular blood pressure checks and urine tests during pregnancy.

  • Blood pressure that exceeds 140/90mm Hg
  • Excess protein in the urine
  • Severe headaches
  • Changes in vision, including temporary loss of vision, blurred vision, or light sensitivity
  • Upper abdominal pain, usually under the ribs on the right side
  • Nausea or vomiting
  • Decreased urine output
  • Decreased levels of platelets in the blood.
  • Impaired liver function
  • Shortness of breath, caused by the presence of fluid in the lungs
  • Sudden weight gain and swelling (edema) particularly in your face and hands may occur with preeclampsia.

Diagnosis of Preeclampsia

For a woman to be diagnosed with preeclampsia, she must have had high blood pressure and one or more of the following signs after the 20th week of pregnancy:

  • Protein in urine (proteinuria)
  • A low platelet count in the blood
  • Impaired liver function
  • Signs of kidney problems other than protein in the urine
  • Fluid in the lungs (pulmonary edema)
  • New-onset headaches or visual disturbances
  • A blood pressure reading in excess of 140/90 mmHg

Tests needed to confirm the diagnosis include:

  • Blood tests: The doctor will order liver function tests, kidney function tests and also measure the platelets to confirm preeclampsia.
  • Urine analysis: Urine is collected for 24 hours, for measurement of the amount of protein in the urine. A single urine sample that measures the ratio of protein to creatinine, a chemical that’s always present in the urine, also may be used to make the diagnosis.
  • Fetal ultrasound: The doctor may also recommend close monitoring of the baby’s heart rate and growth, typically through ultrasound. The images of the baby created during the ultrasound exam allow the doctor to estimate fetal weight and the amount of fluid in the uterus (amniotic fluid).
  • Non-stress test or biophysical profile: A non-stress test is a simple procedure that checks how the baby’s heart rate reacts when the baby moves. A biophysical profile uses ultrasound to measure the baby’s breathing, muscle tone, movement, and volume of amniotic fluid in the uterus.

Treatment of Preeclampsia

The most effective treatment for preeclampsia is the delivery of the baby.  If it’s too early in pregnancy, the delivery may not be the best thing for the baby. Mother will be required to come for more frequent visits than normal with regular tests and close monitoring.

Some medical treatments given include:

1. Medications

  • Medications to lower blood pressure: These medications, called antihypertensive, are used to lower the blood pressure if it’s dangerously high.
  • Corticosteroids: Corticosteroid medications can temporarily improve liver and platelet function to help prolong pregnancy. Corticosteroids can also help a mature baby’s lungs become more mature.
  • Anticonvulsant medications: If preeclampsia is severe, the doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure.

2. Bed rest: Total bed rest is always recommended for women with preeclampsia.

3. Hospitalization: Severe preeclampsia may require that the mother gets hospitalized. In the hospital, the doctor may perform regular non-stress tests or biophysical profiles to monitor the baby’s well-being and measure the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply to the baby.

4. Delivery: For a woman that has been diagnosed with preeclampsia near the end of pregnancy, induction of labor is recommended right away. The readiness of the cervix whether it’s beginning to dilate, efface or ripen may be a factor in determining whether or when labor will be induced. If it’s not possible to wait, the patient will be scheduled for an emergency caesarian section (CS). During delivery, magnesium sulfate is given intravenously to prevent seizures. After delivery, it can take some time before high blood pressure and other preeclampsia symptoms resolve.

Prevention of Preeclampsia

For people with risk factors, there are some steps that can be taken prior to and during pregnancy to lower the chance of developing preeclampsia. These steps can include:

  • Ensure weight loss if overweight
  • Quit smoking
  • Getting blood pressure under control
  • Ensure a regular exercise routine
  • Ensure regular antenatal visits and check-up

Complications of Preeclampsia

Preeclampsia can cause rare but serious complications that include:

  • Fetal growth restrictions
  • Stroke
  • Seizure
  • Heart failure
  • Fluid buildup in the chest
  • Bleeding from the liver
  • Reversible blindness
  • Postpartum hemorrhage

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