Hypertensive disorders of pregnancy remain a major health issue in Anguilla and many other countries. Pre-eclampsia, either alone or superimposed on preexisting hypertension, is a major risk factor. Left untreated, pre-eclampsia can lead to serious — even fatal — complications for both mother and baby. If you have pre-eclampsia, the only cure is delivery of your baby.
What is pre-eclampsia?
Pre-eclampsia 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.
Early signs of pre-eclampsia include having high blood pressure (hypertension) and protein in your urine (proteinuria). It is unlikely you will notice these signs, but they should be picked up during your routine antenatal appointments with your obstetrician or midwife.
In some cases, further symptoms can develop. These include:
• swelling of the feet, ankles, face and hands caused by fluid retention (oedema)
• severe headache
• vision problems
• pain just below the ribs
If you notice any symptoms of pre-eclampsia, seek medical advice immediately by contacting your obstetrician or midwife.
Although many cases are mild, the condition can lead to serious complications for both mother and baby if it is not monitored and treated. The earlier pre-eclampsia is diagnosed and monitored, the better the outlook for mother and baby.
Who is affected by pre-eclampsia?
Pre-eclampsia affects up to 5% of pregnancies, and severe cases develop in about 1-2% of pregnancies.
There are a number of things that can increase your chances of developing pre-eclampsia:
• if it is your first pregnancy
• if you developed the condition during a previous pregnancy
• if you have a family history of the condition
• if you are over 40 years old
• if you are expecting multiple babies (twins or triplets)
If you are thought to be at a high risk of developing pre-eclampsia, you may be advised to take a daily dose of low-dose aspirin from the 12th week of pregnancy until your baby is delivered.
When to see a doctor
Make sure you attend your prenatal visits so that your care provider can monitor your blood pressure. Contact your doctor immediately, or go to an emergency room, if you have severe headaches, blurred vision, and severe pain in your abdomen or severe shortness of breath.
As headaches, nausea, and aches and pains, are common pregnancy complaints, it’s difficult to know when new symptoms are simply part of being pregnant and when they may indicate a serious problem — especially if it is your first pregnancy. If you are concerned about your symptoms, contact your doctor.
What causes pre-eclampsia?
Although the exact cause of pre-eclampsia is not known, it is thought to occur when there is a problem with the placenta (the organ that links the baby’s blood supply to the mother’s).
Treating pre-eclampsia
If you are diagnosed with pre-eclampsia, you should be referred for an assessment by a specialist (obstetrician/gynaecologist).
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 pre-eclampsia 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 37-38 weeks of pregnancy, but it may be earlier in more severe cases.
At this point, labour may be started artificially (induced) or you may have a caesarean section (delivery through an incision in the stomach).
Medication may be recommended to lower your blood pressure while you wait for your baby to be delivered.
If you are diagnosed with pre-eclampsia too early in your pregnancy to deliver your baby, you and your doctor face a challenging task. Your baby needs more time to mature, but you need to avoid putting yourself or your baby at risk of serious complications.
Complications
Although most cases of pre-eclampsia 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 the mother will develop fits called eclampsia. These fits can be life threatening for the mother, and the baby, but they are rare.
Overall, complications of pre-eclampsia are responsible for the maternal deaths in many developing countries. Many babies are affected mostly because of complications of early delivery, such as severe breathing difficulties.
Prevention
Researchers continue to study ways to prevent pre-eclampsia but, so far, no clear strategies have emerged. Eating less salt, changing your activities, restricting calories, or consuming garlic or fish oil does not reduce your risk. Increasing your intake of vitamins C and E has not been shown to have a benefit, and the research into vitamin D is ongoing.
In certain cases, however, you may be able to reduce your risk of pre-eclampsia with:
• Low-dose aspirin. If you had pre-eclampsia in a previous pregnancy that resulted in delivery before 34 weeks’ gestation, or you had pre-eclampsia in more than one previous pregnancy, your doctor may recommend a daily low-dose aspirin — between 60 and 81 milligrams — beginning late in your first trimester.
• Calcium supplements. In some populations, women who have calcium deficiency before pregnancy — and who do not get enough calcium during pregnancy through their diets — might benefit from calcium supplements to prevent pre-eclampsia. However, this is unlikely in women in Anguilla, or other developed countries, where women would have calcium deficiency to the degree that calcium supplements would benefit them.
It is important that you do not take any medications – vitamins or supplements – without first talking to your obstetrician.
Once you are pregnant, take care of yourself — and your baby — through early and regular prenatal care with your obstetrician/midwife. 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.
Conclusion
Pre-eclampsia is a disorder of pregnancy characterized by high blood pressure and large amounts of protein in the urine. Though present in the majority of cases, protein in the urine need not be present to make the diagnosis of pre-eclampsia. The only cure for this condition is delivery of the baby. Regular prenatal care and visits to the doctor/midwife can help to detect this condition and allow for appropriate management. Complications for mother and newborn can be reduced by appropriate management especially if the diagnosis is detected early.
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.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
