Preeclampsia in Pregnancy

Preeclampsia is a disease that affects pregnant women and has been known to cause issues such as poor liver function and fluid in the lungs. Apart from affecting the mother, it also has the potential to cause debilitating complications for the child such as cerebral palsy, blindness and deafness.

What is Preeclampsia?

Formerly called Toxemia Pregnancy, preeclampsia is a pregnancy complication that appears during the last trimester and can lead to issues such as kidney damage and high blood pressure. Mothers-to-be may not display any symptoms if they are afflicted by preeclampsia which is why most doctors insist on checking on your blood pressure during every visit to the clinic. If the blood pressure is high, they will suggest a urine test to check the protein levels in it.

It can also happen during the second half of the pregnancy or anytime up to six weeks post-delivery. Once detected, it needs immediate treatment as it could lead to other health problems like eclampsia and HELLP syndrome (where HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count).

Causes of Preeclampsia

A reduced blood flow towards the placenta is one of the primary causes of preeclampsia and there are no visible symptoms. This happens when the placenta does not place itself properly in the uterus lining and the dilation of the arteries in that area is not enough. Diabetes and chronic hypertension prior to pregnancy could also be reasons for less blood flow to the placenta.

It has also been found that when there is a variation in the blood flow to the placenta, certain placental proteins are released into the bloodstream in large volumes. Because of this, the following reactions are triggered off in your body:

• The blood vessel walls are damaged which leads to swelling of the body and an increase in the level of protein in the urine.
• Blood vessels constrict, thus leading to high blood pressure

Preeclampsia can be also be caused due to other factors such as auto-immune disorders, genetic factors, diet and blood vessel related issues. Your immune system and its reaction to the pregnancy is also thought to be one of the causes of preeclampsia.

Signs and Symptoms of Preeclampsia

Preeclampsia may or may not display any noticeable symptoms and even when it does, the symptoms may differ from one woman to another. People often get confused as preeclampsia has symptoms similar to the normal symptoms of pregnancy such as nausea, weight gain, and swelling. The early stages of preeclampsia may not be typically noticeable and thus need careful monitoring during visits to the doctor.

Speak to your doctor if you notice any unusual swelling in any part of your body as it could be related to preeclampsia swelling. Watch out for the following:

• Swelling of hands and fingers
• Excessive swelling of feet and ankles
• Swelling of the face and neck or puffiness around the eyes
• Rapid increase of weight in a short period of a week or a fortnight

It is to be noted that every pregnant woman who gains rapid weight or has swelling may not be affected by preeclampsia, and the causes for her condition could be different.

Many pregnant women who are affected by preeclampsia have also experienced symptoms like headaches that do not seem to subside and altered vision. Your doctor may also advise urine and blood tests to check the protein level in urine, platelet level and any abnormality of liver enzymes.

Abdominal pain, slower reflexes, less or no urine, nausea and vomiting, and dizziness are also common symptoms associated with preeclampsia. You should ensure that your blood pressure remains in the range of 140/90 and any increase or decrease of these levels warrants a quick visit to the doctor. Regular checks of blood and urine should keep you updated on this.

The following signs are warning signs that could signal preeclampsia:

• Difficulty in breathing
• Vomiting or nausea (especially when it happens in the 2^nd or 3^rd trimester)
• Temporary vision loss, extreme light sensitivity, double vision or blurriness
• Pain in upper abdomen

Who is at the Risk of Getting Preeclampsia?

Those who have had preeclampsia during their first pregnancy are more likely to develop it during subsequent pregnancies. The risk of developing preeclampsia is higher depending on the severity of the condition and when it appears during pregnancy. This could mean that if you have contracted preeclampsia prior to 29 weeks of your pregnancy, then there is a 40% higher chance of contracting it in a later pregnancy.

Though scientific evidence is lacking, Preeclampsia has a high incidence rate among pregnant teens. One study suggests that lack of prenatal care from unwanted pregnancies leaves pregnant teens vulnerable.

Preeclampsia is high among pregnant women above 40 as it puts excess strain on their bodies and may kickstart underlying medical conditions.

Generally, obese women with a Body Mass Index (BMI) of over 30 have an increased risk of preeclampsia as obesity aggravates blood pressure.

Diagnosis

During your scheduled appointments with the doctor, your blood pressure and urine will be under immense scrutiny. Elevated levels of blood pressure and protein in urine are likely to show the presence of preeclampsia. To diagnose preeclampsia, either of the following complications should be present post the 20^th week of pregnancy:

• Low platelet count
• Proteinuria (Protein traces in urea)
• Pulmonary oedema (Fluids in lungs)
• Weakened liver function
• Headaches that have recently begun

During earlier times, it was considered that preeclampsia could happen only if the patient was diagnosed with high blood pressure and if the protein was detected in urine. However, modern doctors are now aware that preeclampsia could occur even if none of its common symptoms are detected.

If your doctor suspects preeclampsia, the following tests may be required:

Protein in Urine:

Your doctor will ask for a urine test that can detect the presence of protein in your urine sample. If this initial test is positive, you will be advised to collect urine after 24 hours so that it can be sent for testing. Known as the most dependable and accurate test for preeclampsia, the presence of 300 mg and above of protein in the urine is a sure sign of preeclampsia.

Monitoring of Blood Pressure:

If your systolic reading is higher than 140 or the diastolic reading is lower than 90, your blood pressure is higher than normal. Since blood pressure fluctuates as per time of the day, your doctor will ask you to check it at different times to confirm that it is high. This is also a reliable pointer towards the diagnosis of preeclampsia for a pregnant woman.

Protein-Creatinine Ratio:

Creatinine is a waste product of the body that is filtered out by the kidney along with other wastes. The Protein-Creatinine ratio is a urine test that checks the presence of this waste product and hence the doctor can understand if the kidney functioning is normal. This test needs one random sample which is better than collecting the 24-hour urine for the urine test. If your test shows the presence of 0.3 mg/dl, it can be concluded that you have been afflicted by preeclampsia.

Foetal Ultrasound:

This test is generally recommended to monitor your baby’s growth closely using the ultrasound method. In this manner, the doctor can estimate the foetal weight and gauge the level of amniotic fluid in the uterus.

Non-stress Test:

This test involves a simple procedure that helps to check the baby’s heart rate and its reaction to movement.

Biophysical Profile:

In this test, an ultrasound is conducted to measure the foetal breathing, movement, muscle tone and the amniotic fluid volume in the mother’s uterus.

Complications

Complications of preeclampsia are rare but they can quickly develop into life-threatening problems such as a low platelet count and a breakdown of red blood cells. Regular monitoring and quick diagnosis can ensure the complications do not grow and the condition is arrested in time.

Complications for the mother:

The following problems can affect the mother if she has been diagnosed with preeclampsia:

Eclampsia: This involves an involuntary contraction of the muscles and can be described as a fit or a convulsion that pregnant women can have. It can occur after the 20^th week or immediately after delivery. During the fit which last for less than a minute, the mother can experience repetitive movements of the arms, legs or neck and she could also lose consciousness.

Stroke: When blood supply to the brain is reduced due to high blood pressure, it can cause cerebral haemorrhage, commonly known as stroke. In this case, the brain does not receive the necessary oxygen from the blood causing the cells to die and thus leading to brain damage or in certain cases, death.

Blood clotting: Medically known as Disseminated Intravascular Coagulation. In this condition, the mother’s blood clotting capacity is severely affected. Here, there is heavy bleeding since the protein level in the blood has drastically fallen or there are a number of blood clots as the proteins have become highly active.

Complications for the baby:

If the mother is diagnosed with preeclampsia, the baby can face the following health issues:

Since there is a low supply of oxygen and nutrients to the baby during preeclampsia, such babies will be smaller in size. This is especially true if preeclampsia occurs prior to 37 weeks of pregnancy. In case the preeclampsia is diagnosed as severe, the doctor may take the decision to deliver the baby earlier. This can lead to breathing difficulties in the baby since the lungs are not fully developed. In some cases, the baby could be stillborn due to early delivery.

What is HELLP Syndrome and Pregnancy Eclampsia?

The HELLP syndrome is a rare blood clotting and liver disorder that is a severe version of pregnancy eclampsia. It is most likely to strike post-delivery, but cases have also been seen after 20 weeks and sometimes before 20 weeks too. The acronym HELLP stands for each of the conditions:

• H is for Haemolysis during which time the red blood cells in the bloodstream break down.
• EL stands for Elevated Liver enzymes which is a sign of damage to the liver.
• LP is for Low Platelet count which is responsible for clotting of blood.

Treatment for Preeclampsia when Pregnant

If you are 37 weeks pregnant or more, labour will be induced especially when the cervix has dilated well. The doctor may also opt for a C-section if they feel that you or your baby will be unable to withstand the pressures of a normal delivery.

Treatment of Severe Preeclampsia

You could be asked to remain at the hospital for regular monitoring if you are diagnosed with severe preeclampsia. A preeclampsia specialist could be assigned to you to give you special care and help in the management of preeclampsia. Medication will be administered to lower blood pressure along with an intravenous infusion of magnesium sulphate to help prevent seizures.

What if Preeclampsia Develops During Labour or After Labour?

If you are diagnosed with preeclampsia during or after labour, monitoring your condition will be of high priority. You will have to stay back at the hospital for a few more days to avoid any further complications that could develop if your blood pressure rises or you get seizures. You will be given magnesium sulphate for up to 24 hours after the delivery to avoid seizures. If you go home, you will have to report back with blood pressure checks conducted for at least a week.

Effects of Preeclampsia on Future Pregnancy

Preeclampsia or toxaemia in pregnancy is a serious condition. However, the mother continues to live with its effects and the risk remains. The effects of preeclampsia on your organs may take at least six weeks to get resolved after delivery. Studies have also shown that there is also an increased risk of hypertension, Type 2 Diabetes, stroke and heart disease. The toxaemia in pregnancy affects the baby by limiting the supply of nutrients to the baby which can change their structure and metabolism. This could lead to coronary heart disease and related disorders including diabetes, stroke and hypertension.

How to Prevent Preeclampsia

Getting prenatal care and not missing on any of your appointments is the key to prevention of preeclampsia. You will have to keep a close watch on your blood pressure and the protein content in your urine to keep toxaemia health-related issues away. As soon as the first signs of preeclampsia are visible, alert your doctor so treatment can be started without any delay. Depending on the severity of the condition, the number of weeks and the baby’s condition, your doctor will decide the line of treatment. This will include numerous urine tests and blood pressure monitoring.

Preeclampsia is one of the foremost causes of maternal mortality and causes foetal mortality as well. However, close monitoring of health conditions of women with a history of high blood pressure and hypertension can be helpful in managing preeclampsia.