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preeclampsia

Preeclampsia

Pre-eclampsia is a pregnancy complication that affects some women, usually during the second half of pregnancy or immediately after the baby is delivered.

What is preeclampsia? | Symptoms | Causes | Risk Factors | Complications | Diagnosis | Treatment | Prevention | Pregnancy-after-preeclampsia

What is preeclampsia?

Preeclampsia is a pregnancy complication that is characterized by high blood pressure, protein in the urine and severe fluid retention. It can also cause damage to other organs, most often the liver and the kidneys. If not treated, preeclampsia can lead to many other serious complications and in some cases, it can be life-threatening.

Symptoms of preeclampsia:

       In most cases, preeclampsia develops without any noticeable symptoms, especially in the early stages. And, even if the symptoms are developed, some of the symptoms of preeclampsia are similar to that of normal pregnancy such as swelling, nausea and weight gain.

But there are some signs of unusual swelling which need immediate medical attention, these include:

  • Swelling of the face or puffiness around eyes
  • Swelling of the hands
  • Sudden or excessive swelling of the feet or ankles

In addition, other possible symptoms of preeclampsia may include:

  • Excess protein in the urine
  • Persistent headaches
  • Changes in the vision, blurred vision or light sensitivity
  • Intense pain or tenderness in the upper abdomen
  • Shortness of breath, due to fluid accumulation in the lungs
  • A decrease in the levels of blood platelets
  • Decreased urine output

Causes of preeclampsia:

       The exact cause of preeclampsia involves several various factors. But, it is believed that preeclampsia is caused by the decreased blood flow to the placenta, the organ that nourishes the fetus throughout the pregnancy. This could happen if the placenta does not implant properly in the lining of the uterus.

Also, early in pregnancy, new blood vessels are developed to efficiently send blood to the placenta. If these newly formed blood vessels don’t develop properly as they should or function properly, the amount of blood flow through them to the placenta will be limited.

Some potential causes may include:

  • Genetic factors
  • Poor nutrition
  • Autoimmune disorders

Risk factors of preeclampsia:

       Preeclampsia is more common during a first pregnancy. Women who have had preeclampsia, are more likely to develop it again in later pregnancies. While it can occur in women who never had high blood pressure before, the other risk factors may include:

  • Having a personal or family history of preeclampsia
  • Having a history of chronic hypertension
  • Being pregnant for the first time
  • Being overweight or obese
  • Carrying more than one baby (twins, triplets or more)
  • Being younger than 20 or older than 35
  • Having interval between pregnancies as short as less than two years and as long as 10 years or more
  • Having In Vitro fertilization
  • Having a history of certain conditions such as diabetes, kidney disease, lupus or rheumatoid arthritis

Complications of preeclampsia:

       If preeclampsia is left undiagnosed or not treated properly, it can lead to serious complications both for the mother and baby. In some cases, it may also lead to life-threatening conditions. Some of the complications of preeclampsia include:

Placental abruption:

              Placental abruption is a condition in which the placenta gets separated from the inner wall of the uterus before delivery. Preeclampsia increases the risk of placental abruption and severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and the baby.

HELLP syndrome:

             HELLP syndrome is a rare liver and blood clotting disorder that can affect women during pregnancy. It is most likely to occur immediately after the baby is delivered but can occur at any time after 20 weeks of pregnancy or even before in rare cases.

HELLP means – H for Hemolysis (break down of red blood cells in the blood), EL stands for elevated liver enzymes which is a sign of liver damage and LP stands for Low platelet count. HELLP syndrome is a more severe form of preeclampsia which can rapidly become life-threatening for both the mother and the baby. It may develop suddenly even before the high blood pressure is detected or it may develop without any symptoms. The symptoms of HELLP syndrome include nausea, vomiting, headache and upper abdominal pain.

Eclampsia (Seizures):

            When preeclampsia isn’t controlled, eclampsia can develop. Since there are no warning signs or symptoms, it is difficult to predict the severity of preeclampsia that can lead to eclampsia. Though the fits usually last less than a minute when a woman develops eclampsia, it can have serious consequences for both mother and baby.

Organ damage:

Preeclampsia can lead to damage to other organs such as

  • Pulmonary oedema – Fluid builds up in and around the lungs which affect the proper functioning of the lungs by preventing them from absorbing oxygen.
  • Kidney failure – Impaired kidney functioning affects the filtering of waste products from the blood. This causes the toxins and fluids to build up in the body.
  • Liver failure – Liver plays an important role in performing vital functions of the body which includes digestion, production of bile and removing toxins. Any disruption to the functions of the liver can be fatal.

Cardiovascular disease:

             Preeclampsia can increase the risk of heart and blood vessel disease in future. The risk is higher in women who had preeclampsia more than once or if they had a preterm delivery. In order to minimize the risk, one should maintain a healthy weight, have a balanced diet and stay away from the possible risk factors.

Fetal growth restriction:

         Preeclampsia affects the blood vessels that carry blood to the placenta. When the placenta doesn’t receive enough blood, the baby may not receive adequate blood and oxygen and nutrients. This results in delayed growth which is referred as fetal growth restriction, low birth weight or preterm birth.

Preterm birth:

            In severe cases of preeclampsia, the baby will be delivered early to minimize the risks for both mother and baby which are referred as preterm births. Prematurity can lead to serious complications such as breathing difficulties as the lungs aren’t developed completely. So, in case of preterm births babies are monitored and treated in neonatal intensive care units till their condition becomes stable.

Diagnosis of Preeclampsia:

            During regular prenatal checkups, every women’s blood pressure and urine are screened. If the doctor finds that the blood pressure is elevated or protein in the urine, the woman will be suggested some tests to confirm the suspicion of preeclampsia. These tests may include:

Blood tests: The doctor prescribes liver function tests, kidney function tests and also measures the count of blood platelets.

Urine analysis: To measure the amount of protein in the urine.

Fetal Ultrasound: It is suggested to monitor the baby’s growth closely. During an ultrasound, the images of the baby are created which helps the doctor to estimate fetal weight and the amount of fluid in the uterus.

Treatment for Preeclampsia:

          The only cure for preeclampsia is to deliver the baby. But, if a woman is diagnosed with preeclampsia in her early pregnancy and delivering the baby isn’t the best thing; then the treatment depends on how severe it is, how far along she is, and how the baby is doing.

As women with preeclampsia are at a higher risk of seizures, placental abruption, stroke and severe bleeding until the raised blood pressure falls to normal, they often need frequent and more prenatal visits, blood tests, and ultrasounds than expected in a normal pregnancy.

Based on the severity of preeclampsia and the baby’s condition, the treatment may include:

Medication:

In case of mild preeclampsia without severe features, the doctor may prescribe medication to,

  • Lower the blood pressure
  • Improve liver and platelet function
  • Prevent seizure and other complications
  • Help baby’s lungs become more mature

Hospitalization:

       In case of severe preeclampsia or if the baby has not developed enough to deliver, the woman needs to be hospitalized. During hospitalization, the doctor may perform regular biophysical profiles that help in monitoring baby’s well being and measure the volume of amniotic fluid.

Also, the blood pressure of the mother will be monitored thoroughly and she might be given intravenous medications to lower the blood pressure it is too high.

Delivery:

          If a woman is diagnosed with preeclampsia near the end of her pregnancy or the baby has developed enough, usually 37 weeks or later; the doctor may induce labour or perform a c-section. In severe cases, waiting for labour to start by itself is not recommended by considering the baby’s gestational age or readiness of the cervix. So, delivering the baby is the only safe option to reduce the risks of preeclampsia both for the mother and the baby.

Though preeclampsia usually improves soon after the baby is delivered, in some cases complications can develop a few days later. So, the doctor may suggest both mother and baby stay in the hospital after delivery to monitor their condition.

If in severe cases of preeclampsia the baby is born prematurely i.e., delivered before the due date, the baby will be admitted to a neonatal intensive care unit. These units have the features that can replicate the functions of a mother’s womb and allow baby to develop completely.

Prevention of Preeclampsia:

       There is no sure way to prevent preeclampsia. But a possible way to prevent preeclampsia is to keep the blood pressure under control. If a woman has chronic high blood pressure, she should lower the blood pressure before pregnancy by working on the factors that contribute to high blood pressure and follow the diet and exercise instructions by the doctor.

Some of the natural ways to control the high blood pressure include:

  • Having a diet low in sodium and rich in fruits and vegetables
  • Drinking 6 – 8 glasses of water per day
  • Avoiding fried and junk food
  • Getting enough rest
  • Regular exercise
  • Avoid beverages that contain caffeine
  • Avoid alcohol consumption

How to plan the next pregnancy after preeclampsia?

       When a woman who has a history of preeclampsia thinks about her next pregnancy, the biggest question would probably be “will this happen again?”. And the answer is women who develop preeclampsia earlier in pregnancy and severely are more likely to develop it in their subsequent pregnancy.

So, when women who had a previous history of preeclampsia are planning for their next pregnancy, they should discuss their medical history and about previous pregnancies with a specialized obstetrician. This helps to understand their own risk factors which include the history of chronic hypertension, obesity or kidney disease or diabetes that makes the management of preeclampsia better during the pregnancy.

The doctor may recommend undergoing some investigations in order to diagnose any underlying health issues that can increase the risk of preeclampsia. This can help the doctors to suggest a treatment plan for safe future pregnancies.

Having a history of preeclampsia in previous pregnancies makes most of the women panic even to think about their next pregnancy. But, many women had healthy pregnancies and babies after experiencing preeclampsia. And to have a safe and healthy pregnancy with a history of preeclampsia one need to seek help from a specialized obstetrician with expertise in managing maternal and fetal health in high – risk pregnancies.

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