Preeclampsia is a serious medical condition that can occur about midway through pregnancy (after 20 weeks), or soon after a baby is delivered. It is one complication of pregnancy that must be managed by experienced and qualified health professionals if more serious complications are to be prevented.
What is preeclampsia?
Preeclampsia is a serious blood pressure condition that develops during pregnancy. Individuals with preeclampsia often have high blood pressure (hypertension) and high levels of protein in their urine (proteinuria). Preeclampsia typically develops after the 20th week of pregnancy. It can also affect other organs in the body and be dangerous for both the pregnant woman and her developing fetus (unborn baby).
The exact cause of preeclampsia involves several factors. Experts believe it begins in the placenta (afterbirth) — the organ that nourishes the fetus throughout pregnancy. Early in a pregnancy, new blood vessels develop and evolve to supply oxygen and nutrients to the placenta.
In women with preeclampsia, these blood vessels do not seem to develop or work properly. Problems with how well blood circulates in the placenta may lead to the irregular regulation of blood pressure in the mother.
Who gets preeclampsia?
Preeclampsia may be more common in first-time mothers. Experts are not entirely sure why some people develop preeclampsia. Some factors that may put a woman at a higher risk of developing preeclampsia are:
• History of high blood pressure, kidney disease or diabetes.
• Family history of preeclampsia.
• Autoimmune conditions like lupus and antiphospholipid syndrome.
• Obesity.
• Being 40 years old or more.
• It is more than 10 years since your last pregnancy.
• expecting multiple babies (twins or triplets).
What are some symptoms and signs of preeclampsia?
Early signs of preeclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria).
It is unlikely that the pregnant woman will notice these signs, but they should be picked up during routine prenatal/antenatal visits. In some cases, further symptoms can develop, including:
• severe headache
• vision problems, such as blurring or flashing
• vomiting
• sudden swelling of the face, hands, or feet
• Shortness of breath, caused by fluid in the lungs
• Pain in the upper abdomen (belly), usually under the ribs on the right side
Weight gain and swelling (oedema) are typical during healthy pregnancies. However, sudden weight gain or a sudden appearance of oedema in the second half of pregnancy — particularly in your face and hands — may be a sign of preeclampsia.
If you are pregnant and notice any symptoms of preeclampsia, seek medical advice immediately by calling your healthcare provider or going to the emergency room at the hospital.
Although many cases of preeclampsia are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated.
The earlier preeclampsia is diagnosed and monitored, the better the outlook for mother and baby.
It is particularly important that all pregnant women share all of their pregnancy symptoms with their midwife/obstetrician or healthcare provider. It should be noted that some women with preeclampsia do not have any symptoms, so it is important that all pregnant women see their midwife or doctor for regular blood pressure checks and other tests.
Treating preeclampsia
If you are diagnosed with preeclampsia, you should be referred for an assessment by a specialist obstetrician.
In most cases you will 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.
A number of medications will be used in the treatment of this serious disorder.
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.
Complications
Although most cases of preeclampsia do not develop serious complications 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 called “eclampsia”. These fits can be life threatening for the mother and baby, but they are rare.
Other complications of severe preeclampsia include:
• Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. This can lead to slow growth known as fetal growth restriction.
• Preterm birth. Preeclampsia may lead to an unplanned preterm birth — delivery before 37 weeks. Also, planned preterm birth is a primary treatment for preeclampsia. A baby born prematurely has increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Treatments before preterm delivery may decrease some risks.
• Placental abruption. Preeclampsia increases your risk of placental abruption. With this condition, the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and baby.
• HELLP syndrome. HELLP stands for haemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count. This severe form of preeclampsia affects several organ systems. HELLP syndrome is life-threatening to the mother and baby, and it may cause lifelong health problems for the mother.
• Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on how severe the preeclampsia is.
• Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease.
Prevention
Medication
The best clinical evidence for prevention of preeclampsia is the use of low-dose aspirin. Your obstetrician may recommend taking an 81-milligram aspirin tablet daily after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia or more than one moderate-risk factor.
It is important that you talk with your provider before taking any medications, vitamins, or supplements to make sure it is safe for you.
All women are advised to see their gynaecologist before having a planned pregnancy, especially if they had preeclampsia before. They should try to be as healthy as possible prior to becoming pregnant, and in conjunction with their healthcare provider try to manage any disorder that might increase their risk of developing preeclampsia.
Conclusion
Preeclampsia is a serious disorder associated with pregnancy. A woman can help protect herself by learning the symptoms of preeclampsia, and by seeing her obstetrician/doctor for regular prenatal care. Diagnosing preeclampsia early may lower the chances of long-term problems for both mother and baby.
Ask Your Doctor 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. Always talk to your doctor for professional medical advice.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
