Pre-eclampsia is one of the critical conditions associated with pregnancy that has an impact on the mother as well as the baby. Most of the time, it develops after the 20th week into the second half of pregnancy. However, the condition can start immediately after delivery. The disease is characterized mostly by high blood pressure and protein in the urine (proteinuria) as signs that may indicate some complications. Pre-eclampsia can lead to very serious complications without timely diagnosis and management, with the risk of life-threatening conditions for both mother and baby. It is thus important to know its symptoms, causes, diagnosis, and treatment to prevent long-term health problems.
Overview
Pre-eclampsia is an obstetric complication that arises in pregnant women. The condition is associated with the development of hypertension and proteinuria. The typical start for the condition is after 20 weeks of gestation and is one of the leading causes of both maternal and fetal morbidity and mortality. Pre-eclampsia must be detected early on, especially to minimize risks both to mother and baby. Eclampsia is a severe complication of pre-eclampsia, characterized by seizures and potentially life-threatening. However, with proper medical care, most women and their babies can survive and recover.
The exact mechanisms of pre-eclampsia are not known, but it is considered to be a problem with the placenta, which is the organ that connects the mother’s blood supply to that of the baby. It is thought that the placenta contributes to the development of pre-eclampsia because it does not develop and function as it should, which causes abnormal blood flow and increased pressure within the mother’s circulatory system.
Key Points:
- Pre-eclampsia affects both the mother and the baby.
- It is marked by high blood pressure and proteinuria.
- The cause is undetermined, though it is speculated that issues associated with the placenta are central to this.
- If severe, it could translate to eclampsia characterized by seizures.
- Monitoring and early detection improve the outcome for mother and child.
Symptoms
The progression of pre-eclampsia is often slow and subtle. Many of its first signs and symptoms are unobservable to the mother. Generally, the only reliable markers identified at routine prenatal visits are the presence of high blood pressure and proteinuria. Yet, for other women, more symptoms would arise that signal that the disorder was worsening. An important point, of course, is that for the most part, pre-eclampsia is asymptomatic at its outset.
Early Symptoms:
- High blood pressure: A reading consistently above 140/90 mmHg is high and may indicate pre-eclampsia.
- Protein in the urine: This is usually found during routine urine tests at antenatal visits.
Further Symptoms:
When pre-eclampsia worsens, other symptoms may include:
- Extreme headache: Persistent severe headaches that do not improve with conventional pain relievers.
- Vision changes: Blurred vision or seeing an aura of flashing lights.
- Pain in the abdomen: Pain or tenderness in the upper abdomen.
- Nausea and vomiting: Abdominal discomfort that starts without apparent nausea or vomiting; it can occur in the second half of pregnancy.
- Sudden swelling: Swelling on the face, hands, or feet – which may occur suddenly and are not related to typical swelling during pregnancy.
Seek immediate medical attention if you have any of these symptoms. Your healthcare provider may further order tests to monitor how severe this condition is and then proceed with what needs to be done.
Early detection and regular monitoring are crucial in improving outcomes for both mother and baby.
Causes of Pre-eclampsia
The exact cause of pre-eclampsia remains unknown. It is, however, believed that it is caused by problems associated with the placenta, an organ that interconnects the mother’s blood supply with that of the baby. In a healthy pregnancy, the placenta feeds and oxygenates the fetus. However, the placenta might not function normally in women who have pre-eclampsia, leading to poor blood flow and the consequent development of high blood pressure. Several factors may contribute to pre-eclampsia development:
- Placental issues: The placenta may not develop or even function normally, impairing blood flow and thereby increasing blood pressure.
- Genetics; and family history of pre-eclampsia contribute to the high risk of occurrence.
- Blood vessel problems; are disorders in the arteries, such as narrowed or decreased blood supply.
- Immune system dysfunction: In some cases, an abnormal immune response may cause inflammation in the blood vessels, contributing to pre-eclampsia.
Risk Factors:
Some risk factors increase the chance of getting pre-eclampsia:
- Pre-existing health conditions. Women who have pre-existing diabetes, hypertension, or kidney diseases are more susceptible.
- Autoimmune conditions. People suffering from diseases like lupus or antiphospholipid syndrome tend to get the condition.
- History of previous pre-eclampsia. If women have previously had a history of the condition during pregnancy, there is an increased risk of experiencing it again in another pregnancy.
- Family history. Women whose first-degree relatives suffered from pre-eclampsia have an increased risk.
- Age: Women who are over 40 years old are more prone to pre-eclampsia.
- Multiple pregnancies: Women carrying twins or other multiples are at a higher risk.
- Obesity: A woman is at a greater risk for having a body mass index of 35 or more.
Prophylaxis:
Low-dose aspirin, that is, 75 to 150 mg daily will be prescribed for women who are considered at high risk, from the 12th week of pregnancy until delivery to possibly prevent the onset of pre-eclampsia.
Diagnosis
Pre-eclampsia is mostly discovered during normal routine prenatal checks through blood pressure surveillance and urinalysis tests. High blood pressure readings accompanied by urinary protein can characterize pre-eclampsia. Health care practitioners conduct additional check-up procedures aside from basic testing to estimate how severe it would be in influencing both mother and baby.
Steps for diagnosis
- Blood pressure: Blood pressure is checked periodically to look for signs of hypertension.
- Urine test: Protein in the urine, known as proteinuria, is commonly tested during routine checkups to confirm pre-eclampsia.
- Blood tests: To evaluate the liver and kidney function and to look for complications such as low platelet count or impaired liver function.
- Ultrasound: To monitor the baby’s growth and amniotic fluid levels.
- Fetal monitoring: It is the tracking of the baby’s heart rate and movements to ensure that all is well within the womb.
In case of suspicion of pre-eclampsia, the patient is referred to a specialist for further evaluation and management.
Treatment
The treatment for pre-eclampsia majorly revolves around managing high blood pressure, avoiding complications, and ensuring the safe delivery of the baby. Pre-eclampsia can only be definitively cured by the delivery of the baby, although doctors will observe the pregnancy to determine when to deliver the baby.
Management Techniques
- Antihypertensive drugs: If there is an increase in the patient’s blood pressure, medication may be used to reduce hypertension and prevent complications.
- Monitoring: Blood pressure, urine, and blood tests should be checked regularly to monitor the degree of pre-eclampsia or severity of the condition and the mother and baby’s well-being.
- Hospitalization: In cases of severe pre-eclampsia, the patient may have to be hospitalized to closely monitor the mother’s health status and manage complications.
Delivery:
- The only treatment for pre-eclampsia involves delivering the baby. The timing is dependent upon the severity of the condition and the gestation age of the baby. Mildly, it may be at 37-38 weeks, but in more severe cases, it might be necessary to deliver them in advanced stages, even by inducing labor or by cesarean section.
- Corticosteroids: If the baby is born before time, then corticosteroids are administered to speed up the development of the baby’s lungs.
Complications
Untreated pre-eclampsia can cause complications both for the mother and the baby.
Maternal Complications:
- Eclampsia: It is a dangerous condition wherein cramps lead to seizures due to severe forms of pre-eclampsia. It may result in coma or death if not treated in time.
- Organ damage: Some organs, including the liver and kidneys, may also be damaged in severe cases of pre-eclampsia.
- Stroke: High blood pressure can increase the chances of having a stroke in pregnancy.
- Placental abruption: In placental abruption, the placenta prematurely detaches from the uterine wall thereby causing severe bleeding and exposure to danger for the mother and the baby.
Fetal Complications:
- IUGR: Poor exchange of nutrition and oxygen through the placenta may result in growth restrictions due to insufficient nutrition and oxygen supply for the baby
- Preterm birth: Excessive pre-eclampsia might necessitate an early delivery, thereby increasing the incidence of potential complications due to prematurity.
- Stillbirth: In some extreme and rare cases, the baby might not survive because of complications caused by pre-eclampsia.
Conclusion
This represents a serious disorder of pregnancy: it requires earlier discovery and careful follow-up to minimize the risks not only to a mother but to her baby also. Regularly scheduled prenatal assessments to monitor blood pressure and urine production are essential measures in managing it. Most females with pre-eclampsia recover shortly following delivery, unless left untreated or until complications surface. Pregnant women with risk factors for pre-eclampsia should be watched very closely and preventive measures taken, such as low-dose aspirin. If the disease is detected early, appropriate treatment and careful management can improve outcomes for both the mother and baby.
