Pregnancy is indeed an exciting chapter of a woman’s life. While expecting for the baby to arrive, it can be a time filled with hopes and dreams for the future child. During this time, the soon-to-be mother may have a lot of anticipation and worries about certain conditions that may arise during pregnancy. One such condition is Preeclampsia.
In this module, we try to address the questions that surround the topic of Preeclampsia.
- What is Preeclampsia?
- What are the causes of Preeclampsia?
- What are the risk factors for developing Preeclampsia?
- What are the signs and symptoms of Preeclampsia?
- How is Preeclampsia diagnosed?
- What are the complications that may arise due to Preeclampsia?
- What are the treatment modalities of Preeclampsia?
- How can one prevent Preeclampsia?
- How is Preeclampsia different from Gestational Hypertension?
1. What Is Preeclampsia?
Preeclampsia, previously known as “Toxemia of Pregnancy”, is characterised by a rise in blood pressure, accompanied by proteinuria (protein in the urine). Edema may or may not be present.
Preeclampsia can be classified as mild or severe.
It can start as early as in the 20th week of pregnancy, in the second trimester, or even postpartum. The incidence varies from 8%-10%.
2. What are the causes of Preeclampsia?
Although the exact cause of Preeclampsia is not known, there are several potential causes:
- Genetic factors
- Reduced blood flow to the placenta – Early in pregnancy, there are new blood vessels that develop and evolve to efficiently transport blood to the placenta. Sometimes, these blood vessels develop or function abnormally. These may be narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them.
- Chronic Hypertension prior to pregnancy
- Immune-mediated causes
3. What are the risk factors for developing Preeclampsia?
Some of the risk factors for developing preeclampsia are:
- Previous history of preeclampsia (during previous pregnancies)
- Multiple pregnancy- more than one fetus.
- Reduced interval between subsequent pregnancies.
- Nulliparous women
- Genetic predisposition- familial incidence.
- Race- incidence is higher among black women
- Complications of pregnancy such as – Hydramnios, vesicular mole etc.
- Maternal Diseases such as – Diabetes, Hypertension, Renal Diseases, Antiphospholipid syndrome.
- New Paternity- the risk of preeclampsia increases with pregnancy with a new partner.
- Age- the risk increases for women over 40 years.
- In-vitro fertilization.
4. What are the signs and symptoms of Preeclampsia?
- Increased Blood Pressure, greater than 140/90 mm Hg- documented on two occasions, at least four hours apart
- Excess protein in the urine (proteinuria) or any other signs of kidney problems
- Decreased urine output
- Abnormal swelling in the hands, fingers, face, neck or puffiness around the eyes.
- Rapid increase of weight in a short period of a week or a fortnight.
The danger signs of severe preeclampsia are as follows:
- Persistent headache
- Epigastric pain
- Decreased platelet count (thrombocytopenia)
- Impaired liver function tests
- Pulmonary edema and cyanosis
- Decreased fetal growth
- Microangiopathic hemolysis
- Vision changes- temporary loss of vision, blurred vision or photophobia
5. How is Preeclampsia diagnosed?
Regular prenatal care ensures that any onset of preeclampsia is diagnosed as early as possible, to prevent complications. The doctor will perform regular Blood Pressure monitoring along with Urine analysis for proteins.
The other investigations that will be done to diagnose Preeclampsia are as follows:
- Complete Blood Count
- Blood biochemistry
- Liver function tests
- Coagulation profile
- Examination of optic fundus
- Fetal ultrasound
- Non-stress tests
6. What are the complications that may arise due to Preeclampsia?
The complications of preeclampsia are often dangerous and may even prove to be fatal. Hence early diagnosis and prompt treatment is required. The complications of Preeclampsia may be divided as:
- COMPLICATIONS FOR THE MOTHER:
- Imminent Eclampsia and Eclampsia
- Cerebrovascular accident or Stroke
- Disseminated Intravascular Coagulation (DIC)
- Pulmonary Edema
- Liver failure
- Kidney Failure
- HELLP syndrome
- Abruptio Placentae
- COMPLICATIONS FOR THE BABY:
- Intrauterine Growth Retardation (IUGR)
- Preterm delivery and premature baby
- Immature lungs leading to breathing difficulties.
7. What are the treatment modalities of Preeclampsia?
The prompt management of preeclampsia is of vital significance, to prevent further deterioration to health of both the mother and the fetus.
The management of Preeclampsia depends on the severity of the condition, and is outlined as follows:
- FOR MILD PREECLAMPSIA
- If significant Hypertension and proteinuria are detected, the patient may be hospitalised to evaluate her and the fetus.
- Rest: The patient is advised additional rest in the afternoon and at night.
- Diet: Salt restriction is not necessary, but additional salt should be avoided. The woman must be encouraged to consume a normal diet.
- Diuretics: They are harmful and to be avoided, and only indicated in Preeclampsia with Pulmonary edema or congestive heart failure.
- Monitoring of the mother: BP is monitored twice daily and urine once daily.
- Monitoring of the Fetus: Fetal growth is assessed clinically as well as sonologically, fetal movements are also monitored.
- Gestation more than 37 weeks: After ensuring fetal maturity, labour is induced or C-section may be performed.
- FOR SEVERE PREECLAMPSIA
- Careful fetal monitoring, including nonstress tests, ultrasounds, heart rate monitoring, assessment of fetal growth and amniotic fluid assessment
- Antihypertensive drugs- The goal of treatment is to lower the diastolic BP between 90 -100 mm Hg.
- The anticonvulsant medication magnesium sulfate, may help prevent progression to Eclampsia
- Early delivery may be performed, when 36 weeks of pregnancy is attained, provided maternal condition is stable or there is no evidence of imminent Eclampsia.
- If maternal condition worsens, or there are signs of imminent Eclampsia, then immediate termination of pregnancy must be done irrespective of Gestational age.
8. How can one prevent Preeclampsia?
The incidence of preeclampsia can be effectively minimized by ensuring that one is up-to-date with their antenatal visits, where BP and Urine will be examined by the doctor. It is also important to let the doctor know in case of any abnormal symptoms, as those mentioned previously.
Besides this, there are a number of ways to stay healthy and prevent Preeclampsia:
- Consuming a healthy, balanced diet
- Exercising moderately
- Maintaining an ideal weight, and gaining the recommended weight during pregnancy
- Managing Diabetes, Hypertension or other chronic conditions effectively
- Good dental hygiene
9. How is Preeclampsia different from Gestational Hypertension?
|DEVELOPMENT||After 20 weeks||After 20 weeks|
|DURATION||Disappears in the postpartum period within 12 weeks||Can be upto 4-6 weeks postpartum|