One of the most serious medical complications during pregnancy is pre-eclampsia. Regular prenatal check-ups during pregnancy are crucial in detecting this life-threatening disorder. Left untreated, preeclampsia can lead to serious — even fatal — complications for both the pregnant woman and her developing fetus.
What is preeclampsia?
Preeclampsia is a condition that affects some pregnant women, usually during the second half of pregnancy (from around 20 weeks) or soon after their baby is delivered. Preeclampsia rarely happens before the 20th week of pregnancy.
Although less common, the condition can also develop for the first time in the first 6 weeks after birth.
The disorder is characterized by high blood pressure (hypertension) and protein in your urine (proteinuria).
Who gets preeclampsia?
Mild pre-eclampsia affects up to 6% of pregnancies, and severe cases develop in about 1 to 2% of pregnancies.
There are a number of things that can increase a woman’s chances of developing preeclampsia:
• having diabetes, high blood pressure or kidney disease before starting pregnancy
• having another condition such as lupus or antiphospholipid syndrome
• having developed the condition during a previous pregnancy
Other things that can slightly increase a woman’s chances of developing preeclampsia include:
• having a family history of the condition
• being over 40 years old
• it having been at least 10 years since your last pregnancy
• expecting multiple babies (twins or triplets)
• having a body mass index (BMI) of 35 or over
If you have 2 or more of these together, your chances are higher.
What causes preeclampsia?
The exact cause of preeclampsia is not fully known at this time. Several factors are involved. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy.
What are some signs and symptoms of preeclampsia?
Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, or it may have a sudden onset. Monitoring a pregnant woman’s blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least four hours apart — is abnormal.
Other signs and symptoms of preeclampsia may include:
• Excess protein in the urine (proteinuria) or additional signs of kidney problems
• 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 your blood (thrombocytopenia)
• Impaired liver function
• Shortness of breath caused by fluid in your lungs
Sudden weight gain and swelling (oedema) — particularly in the face and hands — may occur with preeclampsia, but these also occur in many normal pregnancies, so they are not considered reliable signs of preeclampsia.
Treatment
If you are diagnosed with preeclampsia, you should be referred for an assessment by an experienced obstetrician/gynaecologist. You might need to be admitted to hospital.
While in hospital, you will be monitored closely to determine how severe the condition is and whether a hospital stay is needed.
The only way to cure preeclampsia is to deliver the baby, so you will usually be monitored regularly until it is possible for your baby to be delivered.
This will normally be at around 37 to 38 weeks of pregnancy, but it may be earlier in more severe cases.
Medication may be recommended to lower your blood pressure while you wait for your baby to be delivered. Various tests and investigations will be done to prevent further complications.
Complications
Although most cases of preeclampsia cause no problems, and improve soon after the baby is delivered, there is a risk of serious complications that can affect both the mother and her baby.
There is a risk that the mother will develop fits (seizures) a condition called “eclampsia”. These fits can be life-threatening for the mother and baby. Fortunately, with good management eclampsia can be prevented and is now rare.
Other complications of preeclampsia include the following:
• Fetal growth restriction – resulting in low birth weight.
• Preterm birth.
• Placental abruption – a condition in which the placenta separates from the inner wall of the uterus (womb) before delivery. Severe abruption can cause heavy bleeding which can be life-threatening for both the pregnant woman and her baby.
• HELLP syndrome. HELLP — which stands for haemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count — syndrome is a more severe form of preeclampsia, and can rapidly become life-threatening for both the pregnant woman and her baby.
Conclusion
Preeclampsia is a disorder of pregnancy. The exact cause is not known, but a problem with the placenta is believed to be involved. Early detection of pre-eclampsia is key to successful treatment. All women, once they become pregnant should take care of themselves and their developing fetus through early and regular prenatal care. If you are at risk for preeclampsia, see an experienced obstetrician from very early in the pregnancy and have regular check-ups. If preeclampsia is detected early, you and your doctor can work together to prevent complications and make the best choices for you and your baby.
Ask Your Dr is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-six years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5928).
