Pre-eclampsia

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Pre-eclampsia
Micrograph showing hypertrophic decidual vasculopathy, the histologic correlate of pre-eclampsia. H&E stain.
Synonyms	Toxemia of pregnancy
Pronounce	N/A
Specialty	N/A
Symptoms	High blood pressure, proteinuria, swelling of the hands and feet
Complications	Eclampsia, HELLP syndrome, placental abruption, stroke
Onset	After 20 weeks of pregnancy
Duration	Until delivery
Types	N/A
Causes	Placental dysfunction
Risks	Obesity, diabetes, chronic hypertension, multiple pregnancy
Diagnosis	Blood pressure measurement, urinalysis
Differential diagnosis	Gestational hypertension, chronic hypertension, kidney disease
Prevention	Aspirin, calcium supplementation
Treatment	Delivery, antihypertensive medication, magnesium sulfate
Medication	Labetalol, nifedipine, hydralazine
Prognosis	N/A
Frequency	2–8% of pregnancies
Deaths	46,900 (2015)

Symptoms of pre-eclampsia

Preeclampsia Fishbone Schematic

Pre-eclampsia is a complication of pregnancy characterized by high blood pressure and symptoms of organ system damage, most commonly the liver and kidneys. It typically arises after the 20th week of pregnancy and, if left untreated, can cause major difficulties for both mother and child. In certain circumstances, it may proceed to eclampsia, a potentially fatal illness characterized by convulsions.

Signs and Symptoms

• These are the basic symptoms of pre-eclampsia:
• A systolic blood pressure of 140 mm Hg or higher, or a diastolic blood pressure of 90 mm Hg or higher, on two separate occasions, at least four hours apart.
• Proteinuria is a condition characterized by an excessive amount of protein in the urine, which may indicate renal failure.
• Other symptoms and indicators of pre-eclampsia may include:
• Edema affecting the face, hands, and feet
• Unexpected weight gain
• Extreme headache
• Changes in eyesight, such as impaired vision or seeing spots
• sickness and vomiting
• abdominal discomfort, particularly in the upper right quadrant
• Reduced urine production
• Insufficiency of breath

Causes and Risk Factors

Pre-eclampsia is not completely understood, although it is believed that difficulties with the placenta, the organ that nourishes the fetus throughout pregnancy, are to blame. Among the risk factors for developing pre-eclampsia are the following:

• Original pregnancy
• An earlier diagnosis of pre-eclampsia
• Multiple pregnancies (twins or more)
• Ancestral pre-eclampsia risk
• Chronic hypertension, renal illness, and diabetes are examples of preexisting conditions.
• Obesity
• Superior maternal age (over 35)
• Short interval between pregnancies

Diagnose

Typically, pre-eclampsia is detected using a combination of blood pressure readings and urine tests to detect proteinuria. The following additional tests may be conducted to evaluate organ function and the overall health of the mother and child: Blood tests: To assess liver and renal function in addition to blood clotting factors. Ultrasound: To evaluate fetal development and blood flow to the placenta. To monitor the baby's heart rate and movement during a nonstress exam. The biophysical profile is a mix of an ultrasound and a nonstress test used to determine the general health of the infant.

Therapy

The primary treatment for pre-eclampsia is close blood pressure monitoring and management. Depending on the severity of the illness and the gestational age of the fetus, possible treatments include: Antihypertensive drugs: To decrease blood pressure and prevent problems To aid in controlling blood pressure and promoting fetal growth, bed rest or reduced activity is prescribed. Injections of corticosteroids to help mature the baby's lungs in case of premature birth. Magnesium sulfate is used to prevent seizures in severe pre-eclampsia situations. In some instances, an early delivery may be required to protect the health of the mother and child. Depending on the exact conditions, this may include labor induction or a cesarean section.

Prevention

While there is no way to prevent pre-eclampsia with absolute certainty, there are steps that can be taken to lower the risk: Proper prenatal care: Frequent checkups during pregnancy can aid in the early detection of pre-eclampsia, allowing for prompt treatment. Obesity can raise the risk of pre-eclampsia; therefore, it is crucial to maintain a healthy weight before and during pregnancy. Treating preexisting medical conditions: Conditions such as hypertension and diabetes can be effectively managed to lower the risk of preeclampsia. Dietary and lifestyle modifications: Consuming a well-balanced diet, engaging in regular exercise, and avoiding tobacco and alcohol can contribute to general health and minimize the risk of preeclampsia. In some situations, healthcare professionals may prescribe taking low-dose aspirin during pregnancy to lower the risk of pre-eclampsia, particularly for women with a history of the illness or other risk factors. This should only be performed under the supervision of a medical practitioner.

Complications

Pre-eclampsia can result in major consequences for both mother and child if left untreated, including: The progression of pre-eclampsia to eclampsia, which is characterized by seizures, can be life-threatening for both mother and child.

• HELLP syndrome: A severe form of pre-eclampsia characterized by hemolysis (the breakdown of red blood cells), increased liver enzymes, and a low platelet count, which can lead to liver and kidney failure in addition to other issues.
• Placental abruption refers to the early separation of the placenta from the uterine wall, which can result in serious bleeding and risk the lives of both mother and child.
• Intrauterine growth restriction: insufficient blood flow from the placenta resulting in poor fetal growth.
• Pre-eclampsia may necessitate early delivery of the infant, which can result in prematurity-related difficulties such as respiratory distress syndrome and other long-term health problems.
• Pre-eclampsia can cause harm to the organs of the mother, including the liver, kidneys, and brain.

Summary

Abnormal state of pregnancy characterized by hypertension and fluid retention and albuminuria; can lead to eclampsia if untreated

References

• [1] American College of Obstetricians and Gynecologists. (2019). ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstetrics and gynecology, 133(1), e1-e25.
• [2] Sibai, B. M. (2003). Diagnosis and management of gestational hypertension and preeclampsia. Obstetrics and gynecology, 102(1), 181-192.
• [3] Steegers, E. A., von Dadelszen, P., Duvekot, J. J., & Pijnenborg, R. (2010). Pre-eclampsia. The Lancet, 376(9741), 631-644.

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