Preeclampsia is a condition unique to human pregnancy.
Preeclampsia is a condition unique to human pregnancy.
Preeclampsia is manifested by an increase in blood pressure during pregnancy or immediately after delivery, in pregnant women who had normal blood pressure before pregnancy, accompanied by increased levels of protein in the urine. Rarely, high blood pressure may cause a decrease in platelet count, liver or kidney problems, fluid in the lungs, or signs of brain problems, such as seizures (eclampsia) and / or problems with vision.
The exact cause of preeclampsia is still unknown. Very often you may not have any symptoms and the disease may be discovered by chance during a routine blood pressure measurement and urine test at the antenatal examination at your family gynecologist.
Most women with preeclampsia will give birth to healthy babies and recover completely. However, some women will experience complications, some of them life-threatening for both mother and baby. The mother’s condition can progress to a severe form in a very short period of time.
This disease is relatively common and affects the health of two to eight out of a hundred women during their pregnancy. Fortunately, it is usually in a mild form and has very little effect on pregnancy. However, it is very important to know if you have this disease because in a small number of women it can progress to a much more serious disease. Severe preeclampsia can be a life-threatening condition for both the mother and the newborn.
About one in two hundred women (0.5%) will develop severe preeclampsia during their pregnancy. Symptoms tend to develop at the end of pregnancy, but may also occur for the first time after the delivery.
The symptoms of the so-called. severe preeclampsia include:
These symptoms are serious and, if you experience them, you should seek medical attention immediately.
In severe preeclampsia, other organs may be involved, such as the kidneys or liver, and blood clots may be present. Severe preeclampsia can progress to convulsions (epilepsy-like cramps) before birth or shortly after your baby is born. These seizures are called eclamptic seizures and are rare, occurring in one in 4,000 pregnancies.
Prematurity
Worldwide, preeclampsia is responsible for 20% of all 13 million preterm births each year.
The baby is considered premature if it is born before the 37th gestation week, but there can be serious problems if it is born before the 32nd week of gestation.
The effect of being born prematurely varies widely. Some babies may only need a day or two under intensive care, while others may spend the first months of their lives in intensive care units. Some babies may also have long-term consequences, such as learning difficulties, cerebral palsy, epilepsy, blindness or deafness (especially those born before the 32-nd gestation week and having a very low birth weight – less than 1,500 grams).
Having a premature baby can also mean a lot of emotional and financial stress for the family.
Preeclampsia can cause reduced blood flow through the placenta, limiting the food supply to the baby. As a result, the baby may become malnourished and small for gestational age. Ultrasound can help detect this condition.
Most babies born with IUGR regain weight in the first few months of life, although recent studies suggest that babies born with impaired growth are more likely to develop certain diseases in adulthood, such as diabetes, congestive heart failure and hypertension.
Of the 30 million IUGR babies born worldwide each year, 15% (4.5 million) are associated with preeclampsia.
Mothers should not blame themselves or malnutrition for IUGR as it is caused by underdeveloped placenta and not by the mother’s diet. You can eat everything that is healthy, but if the placenta is not able to transfer nutrients to the fetus, the baby’s growth will be affected.
Your baby survives in the womb by getting nutrients and oxygen from placenta. Poorly developed placenta in pregnancy with preeclampsia contributes to the baby’s body starting to restrict blood flow through the limbs, kidneys and abdomen, in an attempt to preserve the vital blood supply to the brain and heart. As your baby’s oxygen supply is depleted, its body will begin to produce too much lactic acid. If too much lactic acid builds up, the baby will develop acidosis and lose consciousness by stopping movements. Childbirth is essential at this time, even if the baby is immature.
Preeclampsia is associated with a number of long-term consequences for premature babies, such as learning difficulties, cerebral palsy, epilepsy, blindness and deafness. Prematurity also carries the risk of prolonged hospitalization, low birth weight for gestational age, and disruption of significant family bonding time. Prematurity causes stress in the family, and this stress is even greater if the mother is also ill.
An integrated baby and mother care system can reduce some of the above consequences. This includes early diagnosis of preeclampsia; monitoring the condition of the fetus; use of magnesium sulphate, both for the prevention of maternal seizures and for neurological protection of the new-born; safe preterm delivery when indicated and ensuring necessary intensive care for preterm infants. Nevertheless, further research is needed. Effective treatment should be found that does not involve childbirth.
For the time being, the only “cure” for preeclampsia is childbirth and placenta. When preeclampsia is diagnosed in pregnancy, the mother and her unborn baby should be closely monitored. There are medications and treatments (symptomatic) that can prolong pregnancy, which can increase the baby’s chances of survival. Once preeclampsia develops, it cannot be stopped. In some cases, the baby must be born immediately, without delay, in order to save the life of the mother or the baby.
Obstetricians say that treatment begins with childbirth since the woman is still at risk of preeclampsia and other hypertensive disorders during pregnancy and after childbirth. Therefore, it is essential that every woman continues to control her condition for at least another 6 weeks after childbirth.
Preeclampsia can develop in any pregnancy, but you have a higher risk if:
If any of the above are present in you, it is advisable to start taking 75-150 mg of aspirin once a day, no later than the 16th week of gestation.
The significance of other risk factors is less clear, but you have a higher risk of developing preeclampsia than the general population if you have more than one of the following risk factors:
If you are diagnosed with preeclampsia, you should be hospitalized. Your blood pressure will be measured regularly during your hospitalization and, if necessary, you will be given treatment to lower it. Your urine will be tested to measure the exact amount of protein in it and a detailed blood count analysis will be done. Your baby’s heart rate will be monitored and an ultrasound will be carried out to monitor your baby’s growth and well-being.
This monitoring is continued until the results show that you can safely continue your pregnancy. These tests can also be carried out on an outpatient basis if you have a mild form of preeclampsia. However, if you have a severe form of preeclampsia and if there is a danger to your health or the well-being of your baby, you may have to give birth earlier, either with the so-called induced preterm delivery or premature caesarean section. All this is left to the assessment of the experienced obstetrician.
Each decision of the obstetrician should be explained to the patient.
Preeclampsia usually passes after childbirth. However, if the patient has a severe form of preeclampsia, complications can occur in the first few days after delivery and therefore the patient should be monitored intensively. When she is discharged from the hospital, she will receive advice from her doctor on how often to measure her blood pressure and how long to take the pills. Six to eight weeks after delivery it is necessary to check with the family gynecologist to assess whether her blood pressure has normalized and check the urine for the presence of protein. If high blood pressure is found after the sixth week of delivery or protein is present in the urine, the patient should be referred to nephrologist because it is likely to be previously undiagnosed chronic hypertension.
One in six women who have had preeclampsia will develop it again in their next pregnancy.
One in two women will have preeclampsia again in the next pregnancy if the baby had to be born before the 28th week of gestation.
One in four women will have preeclampsia again in the next pregnancy if the baby had to be born before the 34th gestation week.
Each patient should be explained the possibility of recurrent preeclampsia in the next pregnancy and the need for additional treatment to prevent it.
