Preeclampsia

Preeclampsia is a medical condition developed in pregnant women. It’s characterised by high blood pressure in women who have not suffered from high blood pressure before pregnancy. Women with preeclampsia have increased levels of protein in urine called as proteinuria, along with swelling in the legs, feet, and hands.

Preeclampsia usually occurs during late stages of pregnancy i.e. after the 20^th week of gestation. However, in rare cases, it can appear earlier. If left undiagnosed and untreated, preeclampsia can further lead to eclampsia which is a life-threatening condition for the mother and the baby. Eclampsia is characterized by high blood pressure along with persistent seizures.

Signs and Symptoms

Preeclampsia can develop without any noticeable symptoms. A pregnant woman may become severely hypertensive during any stage of her pregnancy. This is why blood pressure monitoring is an important aspect of prenatal care. Blood pressure reported 140\90mm Hg or more, on more than one occasion in a single day, is not normal and needs to be taken seriously.

Other poignant signs and symptoms of preeclampsia are:

• High levels of protein in urine i.e. proteinuria.
• Signs of a renal disease such as abdominal pain or difficulty in urination
• Severe headaches
• Vision problems which include light sensitivity or blurred vision, and in severe cases, there’s temporary loss of vision.
• Decreased urine output
• Nausea and vomiting
• Low level of blood platelets i.e. thrombocytopenia
• Impaired hepatic function
• Shortness of breath due to fluid retention in lungs
• Swelling or edema in your hands and feet
• Sudden weight gain

Causes

The definite cause of preeclampsia is still unknown. However, experts believe that it starts in the placenta which is an organ that provides nourishment to the fetus during pregnancy. There’s development of new blood vessels during pregnancy for effective blood supply to the placenta. In case of women with preeclampsia, the new blood vessels are not properly developed. They are narrower as compared to the normal blood vessels and react abnormally to hormonal changes. This leads to increased pressure of blood as it passes through these narrow blood vessels which can eventually lead to preeclampsia.

Other causes of preeclampsia may include:

• Immunological problems
• Damage of the blood vessels
• Environmental pollutants such as smoke
• Gene mutation

Chronic Hypertension Along With Superimposed Preeclampsia

It’s a condition which develops in women who suffer from chronic hypertension before pregnancy. The hypertension furthers increases during pregnancy along with very high levels of protein in the urine. It’s a serious condition and the treatment is the same as that of preeclampsia.

Risk factors

The risk factors of preeclampsia include:

• First Pregnancy: There are increased chances of the development of preeclampsia during the first pregnancy.
• Family History: A family history of preeclampsia increases your chances of suffering from it.
• New Paternity: Every pregnancy with a new partner raises the risk of preeclampsia development as compared to repeated pregnancies with an old partner.
• Age: Pregnancy in older women i.e. more than 40 years of age, increases the chances of preeclampsia.
• Obesity: Obese women are at higher risk of preeclampsia development
• History of Medical Issues: Having certain medical problems before pregnancy significantly increase the chances of preeclampsia development. Such conditions are; Type 1 or Type 2 Diabetes, migraine, chronic hypertension, renal diseases, and tendency for development of blood clots.

Complications

The severity and early onset of preeclampsia increases the risks for the mother and the baby. Preeclampsia usually requires labor induction and delivery of the baby. However, it’s not necessary to opt for the cesarean section unless there are other problems too, such as; a fetus in breech presentation. However, C-section is a must if the delivery is required before the completion of 30 weeks of gestation.

Complications of preeclampsia include:

• Decreased Blood Flow to the Placenta: The arteries carrying blood to the placenta are affected. This leads to decreased blood transfer in the placenta and the baby receives decreased oxygen and nutrients. This leads to poor growth of the fetus, low birth weight, or even preterm birth. The baby can also develop respiratory problems such as asthma.
• Placental Abruption: There are increases chances of placental abruption in case of preeclampsia. The placenta gets separated from the uterus’s inner wall before delivery. This leads to heavy bleeding and it can be a life-threatening condition for both the mother and the baby.
• HELLP Syndrome: It’s a combination of the red blood cells breakdown i.e. Hemolysis, increased liver enzymes, and decreased platelet count. Preeclampsia can lead to the development of HELLP which can be a life-threatening condition as it causes severe damage to other organs such as the liver, kidneys, and lungs.
• Cardiovascular Diseases: Preeclampsia increases the chances of other cardiovascular diseases such as Angina, and Myocardial Infarction.

Management

There’s no complete cure of preeclampsia. The best option is the baby’s delivery as the mother is always at a great risk of placental abruption, seizures, bleeding, and even a stroke. If the woman is too early in the pregnancy, then delivery is not possible and the doctors manage the preeclampsia with the following medications.

Antihypertensive Agents

The doctors try to lower the blood pressure with the use of antihypertensive agents. However, all antihypertensive are not safe during pregnancy as they may cross the placental barrier and cause serious damage to the fetus. Your doctor may prescribe long-acting Nifedipine, Methyldopa, and Labetalol to lower your blood pressure as these drugs can’t cross the placental barrier.

Corticosteroids

Corticosteroids can improve the platelet count and liver function in case you are suffering from HELLP syndrome and severe preeclampsia. They can prolong your pregnancy and can cause faster maturation of the baby’s lung which is extremely important in case you’re aiming for a pre-term birth.

Anticonvulsants

If your eclampsia is extremely severe, then the doctors can prescribe anticonvulsant drugs such as Magnesium Sulfate in order to prevent the seizures.

The blood pressure usually returns to normal within 10 weeks after the delivery, or even sooner. Preeclampsia is a serious medical condition for pregnant women, which must be managed in a timely manner in order to ensure the safety of the mother and the baby.

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