Definition and Overview

Preeclampsia is a pregnancy-specific multi-organ disorder that commonly occurs in the second half of pregnancy. It is characterised by vascular damage that results in high blood pressure (more than 140/90 mm Hg) and proteinuria or the presence of abnormal amounts of protein in the urine due to kidney problems.

Preeclampsia accounts for about 15% of premature births in the United States. It is one of the four high blood pressure disorders that can occur during pregnancy. The other three are gestational hypertension, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Preeclampsia is especially a cause for concern because it can lead to damage to vital organs including the kidneys, brain, liver, and placenta. Also, as the term suggests, it can develop into eclampsia in which the mother suffers from seizures often followed by coma.

Most cases of preeclampsia are mild and do not cause long-lasting problems for both the mother and the baby as long as the condition is diagnosed early and adequately managed with ample bed rest and medications. In fact, many women with the condition are able to deliver their babies near full term without any problems or complications.

The definitive cure for the condition is to deliver the placenta, which can be an option if preeclampsia is diagnosed close to the end of pregnancy.

Causes of Condition

Doctors are unsure as to what causes preeclampsia. However, there are theories suggesting that it begins in the placenta, an organ that develops in the uterus during conception and is responsible for nourishing the foetus until birth. Preeclampsia can occur if newly developed blood vessels that are supposed to supply blood to the placenta are narrower than normal or do not properly respond to hormonal signals.

Factors that can contribute to the development of this disorder include:

  • Autoimmune and blood vessel disorders

  • Genetics

  • A family or personal history of preeclampsia

  • Chronic hypertension

  • Certain medical conditions including diabetes and kidney disease

  • In vitro fertilisation (IVF) - Research suggests that the risk of preeclampsia is slightly higher if a baby was conceived through IVF.

Key Symptoms

The most telling signs of preeclampsia are high blood pressure and protein in the urine, which are diagnosed during regular prenatal check-ups through routine urine tests and blood pressure reading.

Other symptoms of preeclampsia include:

  • Changes in vision including light sensitivity, blurred vision and even temporary loss of vision

  • Severe, persistent headaches

  • Pain on the right side of the abdomen

  • Thrombocytopenia, or low amount of platelets

  • Impaired liver function

  • Shortness of breath

  • Abnormal swelling of the face and hands

  • Other signs of kidney problems, such as decreased urine output

Unless diagnosed and treated early, the condition can result in serious complications including stroke, seizures, and placental abruption in which the placenta separates from the inner wall of the uterus. When this happens, the patient will experience preeclampsia symptoms that can threaten the lives of both the mother and foetus.

Aside from eclampsia, the other severe complication that patients face is HELLP syndrome, which stands for haemolysis, elevated liver enzymes, and low platelet count. It is very dangerous because it signifies serious damage to several organ systems.

Who to See and Types of Treatments Available

The keys to successful preeclampsia treatment are prompt diagnosis and timely, effective therapeutic intervention. Upon preeclampsia diagnosis, doctors focus on lowering and stabilising the mother’s blood pressure and improving liver and kidney function with the goal to prolong the pregnancy until it is safe for the foetus to be delivered.

The condition can be either mild or severe. Mild preeclampsia is characterised by a blood pressure reading of 140/90 or more and the presence of at least 0.3 grams of protein in the urine. Severe preeclampsia, on the other hand, is when the mother’s blood pressure is 160/110 or higher and if three or more grams of protein are detected in two random urine samples collected at least four hours apart. There is also liver damage and patients suffer from severe weight gain and difficulty breathing due to excessive fluid build up in the body.

To assess the severity of the condition, the following tests are carried out:

  • Blood tests to check the mother’s liver and kidney function. This is also performed to check how well the mother’s blood is clotting and to count the total number of red blood cells.

  • Ultrasound to check foetal growth and development

  • A thorough physical exam

  • Laboratory tests, which are performed if HELLP syndrome is suspected

Mild cases of preeclampsia are managed with bed rest and medications including antihypertensives, anticonvulsants, and corticosteroids, which help improve platelet count and liver function. Patients’ prenatal visits are scheduled more frequently than what is typically recommended for normal pregnancy so they can be closely monitored for possible complications. They are also commonly given a list of preeclampsia signs that should prompt them to seek immediate medical attention.

Severe preeclampsia, on the other hand, may require hospitalisation to effectively monitor both the mother’s and baby’s health. The volume of amniotic fluid is measured on a regular basis and the mother is given regular steroid injections to help speed up the development of the baby’s lungs. If diagnosed near the end of the pregnancy, many doctors recommend induced labor or Caesarian section. Preeclampsia goes away after delivery and in many cases, patients experience complete symptoms relief within six weeks after delivery.

Prevention

Because preeclampsia causes are yet to be determined, there are currently no definitive guidelines that can help pregnant women to prevent it from occurring. However, maintaining a healthy diet and exercising regularly can help. Doctor encourage women who want to conceive to work on getting into a good physical shape before getting pregnant. This is proven to help in lowering their risk of developing preeclampsia and other pregnancy complications.

References:

  • Rosene-Montella K. Common medical problems in pregnancy. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 239.

  • Meher S, et al. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003514.pub2/full.

  • Main, Elliott K., McCain, Christy L., Morton, Christine H., Holtby, Susan, Lawton, Elizabeth S., “Pregnancy-Related Mortality in California: Causes, Characteristics, and Improvement Opportunities.” Obstetrics & Gynecology.

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