Preeclampsia - Pregnancy Complications

Preeclampsia is a condition characterized by high blood pressure, protein in the urine, and swelling of the hands and face that occurs after 20 weeks of pregnancy.

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It occurs in about 10 to 15% of pregnancies and is more common with the first pregnancy, in teenagers, and in women over 35. While it can occur in the late second trimester, preeclampsia is much more common in the third trimester, near term. Preeclampsia can lead to eclampsia (seizures), kidney failure, and rarely death in the mother and fetus.

Cause of Preeclampsia

Despite years of scientific study, the true cause of preeclampsia is not known, nor is there any effective prevention. The cure, however, has been known for many decades, and that is delivery of the baby. For that reason, timely diagnosis and delivery is the best way to avoid serious problems for the mother and for the fetus.

Signs and Symptoms

Initially, preeclampsia causes

high blood pressure (hypertension)
protein in urine (proteinuria)

High blood pressure affects 10-15% of all pregnant women, so this alone doesn’t suggest preeclampsia. However, if protein in the urine is found at the same time as high blood pressure, it’s a good indicator of the condition.

As preeclampsia progresses, it may cause:

severe headaches
vision problems, such as blurring or seeing flashing lights
severe heartburn
pain just below the ribs
nausea or vomiting
excessive weight gain caused by fluid retention
feeling very unwell
sudden increase in oedema – swelling of the feet, ankles, face and hand

Without immediate treatment, preeclampsia may lead to a number of serious complications, including:

convulsions (eclampsia)
HELLP syndrome (a combined liver and blood clotting disorder)
stroke

However, these complications are rare.

Diagnosis

Many women have no symptoms at first. Others have headaches, vision changes, and upper abdominal pain. These signs may suggest severe preeclampsia. The first sign that doctor usually sees is high blood pressure during a routine prenatal visit.

Protein may be detected in urine, and may have gained excessive weight. Sometimes hands and face are swollen, but this is frequently absent in mild disease. Blood tests, such as liver and kidney function tests and blood clotting tests, may confirm the diagnosis and can detect severe disease.

Treatment

Inducing labor is recommended for term pregnancies and for preterm pregnancies that are unstable or in which the baby’s lungsare mature
If mild preeclampsia develop long before due date, doctor may monitor mother and the fetus and allow the fetus to mature more. If mother is near term, if the baby’s lungs are mature, or if severe disease develops, labor is induced. All women with preeclampsia should be put on magnesium sulfate therapy during labor and after delivery for about 24 hours to reduce the risk of seizures.
If severe preeclampsia occurs when the fetus is very preterm (about 24 to 32 weeks), doctor may try to prolong pregnancy to allow fetal growth. Women are hospitalized, monitored carefully, and given steroids to help mature the baby’s lungs. If doctor sees signs of worsening disease, she might induce labor or deliver baby by cesarean section. Magnesium sulfate is also used to help prevent seizures.

In severe preeclampsia, doctor will focus on preventing eclampsia, controlling blood pressure, and delivering the baby.

Complications of preeclampsia

Problems affecting the mother

Fits (eclampsia)

Eclampsia describes a type of convulsion or fit (involuntary contraction of the muscles) that pregnant women can experience, usually from week 20 of the pregnancy or immediately after the birth.

During an eclamptic fit, the mother’s arms, legs, neck or jaw will twitch involuntarily in repetitive, jerky movements. The fits usually last less than a minute.While most women make a full recovery after having eclampsia, there’s a small risk of permanent disability or brain damage if the fits are severe. Of those who have eclampsia, around 1 in 50 will die from the condition.

Unborn babies can suffocate during a seizure and 1 in 14 maydie.Research has found that a medication called magnesium sulfate can halve the risk of eclampsia and reduce the risk of the mother dying.

It’s now widely used to treat eclampsia after it has occurred, and to treat women who may be at risk of developing it.

HELLP syndrome

HELLP syndrome is a rare liver and blood clotting disorder that can affect pregnant women. It’s most likely to occur immediately after the baby is delivered, but can appear any time after 20 weeks of pregnancy, and in rare cases before 20 weeks.

The letters in the name HELLP stand for each part of the condition:

“H” is for haemolysis– this is where the red blood cells in the blood break down
“EL” is for elevated liver enzymes (proteins) – a high number of enzymes in the liver is a sign of liver damage
“LP” is for low platelet count – platelets are substances in the blood that help it to clot

HELLP syndrome is potentially as dangerous as eclampsia, and is slightly more common. The only way to treat the condition is to deliver the baby as soon as possible. Once the mother is in hospital and receiving treatment, it’s possible for her to make a full recovery.

Stroke

The blood supply to the brain can be disturbed as a result of high blood pressure. This is known as a cerebral haemorrhage, or stroke. If the brain doesn’t get enough oxygen and nutrients from the blood, brain cells will start to die, causing brain damage and possibly death.

Organ problems

Pulmonary oedema– where fluid builds up in and around the lungs. This stops the lungs from working properly by preventing them from absorbing oxygen.
Kidney failure – when the kidneys cannot filter waste products from the blood. This causes toxins and fluids to build up in the body.
Liver failure – disruption to the functions of the liver. The liver has many functions, including digesting proteins and fats, producing bile and removing toxins. Any damage that disrupts these functions could be fatal.

Blood clotting disorder The mother’s blood clotting system can break down. This is known medically as “disseminated intravascular coagulation“. This can either result in too much bleeding because there aren’t enough proteins in the blood to make it clot, or in blood clots developing throughout the body because the proteins that control blood clotting become abnormally active.

These blood clots can reduce or block blood flow through the blood vessels and possibly damage the organs.

Problems affecting the baby

Babies of some women with preeclampsia may grow more slowly in the womb than normal, because the condition reduces the amount of nutrients and oxygen passed from the mother to her baby.

These babies are often smaller than usual, particularly if the preeclampsia occurs before 37 weeks. If preeclampsia is severe, a baby may need to be delivered before they’re fully developed.

This can lead to serious complications, such as breathing difficulties caused by the lungs not being fully developed (neonatal respiratory distress syndrome).

In these cases, a baby usually needs to stay in a neonatal intensive care unit so they can be monitored and treated.Some babies of women with preeclampsia can even die in the womb and be stillborn. It’s estimated that around 1,000 babies die each year because of preeclampsia. Most of these babies die because of complications related to early delivery.

Preeclampsia rapidly disappears after delivery. In rare cases, a woman needs blood pressure medication for a short time or diuretics to treat pulmonary edema (fluid in the lungs). While preeclampsia is primarily a disease of first pregnancies, there is an increased risk of recurrence with future pregnancies.

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