Pre-eclampsia

Symptoms Of Pre-eclampsia

Initial signs and symptoms:

• High blood pressure (hypertension). 

• Protein in the urine (proteinuria)

Further symptoms might include:

• Sudden swelling in the feet, face and hands. 

• Changes in vision leading to blurriness, seeing spots/flashing lights, or sensitivity to light

• Abdominal pain on the right side, just below the ribs

• Nausea and vomiting

• Severe headache that doesn’t fade away or becomes worse

• Dizziness

• Mental confusion

• Altered behavior

• Shortness of breath

• Malaise or general feeling of being unwell
  
  

Severe signs and symptoms of pre-eclampsia include: 

• Very high blood pressure (160/110 mmHg or higher)

• Decreased liver and kidney functioning 

• Pulmonary edema (Fluid in the lungs)

• Thrombocytopenia (low platelet count)

• Low urine output

• Restricted fetal growth.

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Causes Of Pre-eclampsia

Although the exact cause of pre-eclampsia is not known, it is believed to occur when there's a problem with the placenta, the specialized organ that develops inside the womb to give the baby the food and oxygen it needs to grow. 

Compromised blood supply to the placenta in the case of pre-eclampsia, can lead to problems in the mother and the fetus. Many risk factors associated with the same are discussed in the next section.

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Risk Factors For Pre-eclampsia

The precise reason behind pre-eclampsia remains uncertain, but specific risk factors can elevate the chances of developing it. These include:

1. High-risk factors

• Previous pre-eclampsia 

• Chronic kidney disease

• Chronic hypertension

• Diabetes mellitus 

• Systemic Lupus Erythematosus (SLE)

• Sickle cell anemia

• Blood Vessel problems

• Obesity (body mass index ≥30 kg/m2)

• Infertility treatments (assisted reproductive therapy) 

• Multiple pregnancies (eg. twins or triplets).

• Having multiple moderate risk factors

2. Moderate-risk factors

• First pregnancy

• Age above 40 years

• Prior placental abruption (where the placenta separates from the inner wall of the uterus before delivery)

• Prior stillbirth 

• Prior fetal growth restriction

3. Rare risk factors

• Family history of preeclampsia

• Trisomy 13 (a genetic disorder which can lead to a range of physical and intellectual disabilities)

• Gum diseases, urinary tract infections and helicobacter pylori infections.

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Diagnosis Of Pre-eclampsia

The diagnosis of preeclampsia is crucial as it may not present with any symptoms at first. It include's

1. Physical examination and medical history 

Physical examination helps identify signs and symptoms of preeclampsia, such as high blood pressure (more than 140/90 mmHg), and swelling. Medical history is taken to assess risk factors, augment diagnosis and form treatment decisions.

2. Urine analysis 

This is done to check proteins in the urine. It can easily be tested for protein using a dipstick (it is a strip of paper that's been treated with chemicals so it reacts to protein, usually by changing color). If a concentration of protein is present in urine it is sent for further testing.

3. Blood tests 

• Placental growth factor (PIGF): This is a gold standard test in the prediction, diagnosis, and treatment of preeclampsia. It assesses the severity of the condition by measuring the levels of this specific protein in the blood.

• Circulating soluble fms-like tyrosine kinase-1: This test measures the levels of this protein tyrosine kinase, which can be elevated in this condition.

• Kidney Function tests (KFT): This test is done to assess the kidneys as preeclampsia can be due to kidney disease. Assessment is also done to check for any damage to the kidneys.

• Liver Function tests (LFT): Liver abnormalities occur in 3% of pregnancies, and preeclampsia is the most frequent cause. 

• Blood platelet: Thrombocytopenia (a condition that occurs when the platelet count in the blood is too low) is the most common hematological abnormality observed in preeclampsia. This test is done to check whether blood clotting is taking place properly or not. 

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4. Imaging tests

• Fetal ultrasound: While it is not a direct method for diagnosing preeclampsia in the mother, it can provide valuable information about the baby's health and development.

• Nonstress tests (NST): These tests involve monitoring the baby's heart rate in response to its own movements. They can help determine if the baby is under stress due to potential complications arising from the mother's condition. 

• Cardiotocography: It is a monitoring method that records the baby's heart rate and the mother's uterine contractions. In preeclampsia, CTG can be useful for assessing fetal well-being. 

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Prevention Of Pre-eclampsia 

Though preeclampsia cannot be prevented in all cases, some steps can be taken to reduce the risk of developing preeclampsia. These include:

Maintain blood sugar and blood pressure levels in the right range

During pregnancy, the target range for blood sugar levels is typically 60-99 mg/dL before meals and 100-129 mg/dL after meals. Blood pressure should ideally be around 120/80 mm Hg. However, specific targets may vary.

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Target a healthy weight gain during pregnancy

If you are already overweight, you can put on 7kg to 11.5kg of weight during pregnancy. If you are in the normal weight range, you can target 11.5kg to 15.8kg of weight gain.

Consume a healthy, wholesome and balanced diet

Focus on the quality of food that you consume. Make sure to get a nutrient dense diet rich in whole grains, nuts, legumes, fruit, vegetables, and dairy products. Limit the intake of salt, sugar caffeine, processed and packaged foods.

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Get a good night's sleep 

Lack of good quality sleep is associated with stress and a higher risk of pregnancy complications including preeclampsia.

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Engage in regular exercise

Mild physical exercises during pregnancy, including swimming, walking, yoga, and mild stretching, improves blood flow to tissues and organs and maintains cardiac health. 

Note: It is important to evaluate risk v/s benefits of exercise for the prevention of preeclampsia with your doctor.

Manage stress efficiently

Several studies emphasize the role of stress in the development of preeclampsia. You can try practicing yoga, meditation, listening to soft music, spending time in nature, and deep breathing exercises to manage stress.

Medication

If you have one high-risk factor or more than one moderate-risk factor for preeclampsia, the use of low-dose aspirin is usually advised after 12 weeks of pregnancy. Consult your doctor before taking any medications to make sure it's safe for you and your baby.

Specialist To Visit

Specialists that can help you diagnose and treat preeclampsia include:

• Obstetrician and gynecologist

• Perinatologist

An obstetrician & gynecologist specializes in diagnosing and treating diseases of the female reproductive system along with delivering babies and providing medical care during pregnancy and after birth. 

A perinatologist is an obstetrician who specializes in high-risk pregnancies. 

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Treatment Of Pre-eclampsia 

The cure for preeclampsia is giving birth. The doctor will assess when to deliver based on how far is the mother due, and the severity of preeclampsia.

• If the baby is close to full term (37 weeks pregnant or more), the doctor may advise to induce labor or do a cesarean section.

• If the baby is not close to term, the mother will be monitored closely and regularly for the following :

• Blood pressure

• Level of protein in the urine

• Blood check-ups- including liver or kidney function tests 

• Baby’s heart rate

• Ultrasound scans to check blood flow through the placenta, growth of the baby, amount of amniotic fluid amongst other factors.

The idea is to prolong the pregnancy and allow the baby to grow and develop. The closer the birth is to the due date, the better it is for the baby.

The following will be advised to manage preeclampsia and its potential complications:

• Bed rest, either at home or in the hospital, depending on the severity of preeclampsia. It is advised to sleep or lie down mostly on the left side.

• Medications to lower blood pressure: Some examples include:

• Labetalol

• Nifedipine 

• Hydralazine

• Medications to promote the baby's lung maturity: Steroids like:

• Betamethasone

• Dexamethasone

• Medications to prevent eclampsia-related seizures: 

• I.V. Magnesium 

Post-delivery management

• Preeclampsia usually improves soon after the baby is born, but a few complications can sometimes develop a few days later.

• The mother’s blood pressure should be monitored carefully and medicines should be administered carefully. 

• The baby that is born prematurely will be kept and monitored in the neonatal intensive care unit. 

• The mother should have her blood pressure checked regularly after leaving the hospital, and she may need to continue taking medicine to lower her blood pressure for several weeks.

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Complications Of Pre-eclampsia 

Many cases of pre-eclampsia do not pose serious problems and improve soon after the delivery of the baby. However, in some cases, if it is not diagnosed and treated timely, it can pose serious complications to both the mother and the baby.

Complications affecting the mother 

• HELLP syndrome: HELLP is an acronym that stands for 

  • Hemolysis (premature red blood cell breakdown)

  • Elevated liver enzyme levels

  • Low platelets (cells involved in blood clotting)

• Stroke: The blood supply to the brain can be disrupted as a result of high blood pressure leading to a stroke. 

• Fits (eclampsia): In rare cases, eclampsia, a type of seizures or coma fit might develop. During the fit, the mother's arms, legs, neck, or jaw will twitch involuntarily in repetitive movements.

• Organ problems: 

  • Kidney failure

  • Liver failure

  • Heart attack and cardiovascular issues

  • Acute respiratory distress

  • Blood clotting disorder

  • Eye complications

Complications affecting the baby

• Fetal growth restriction

• Placental abruption

• Premature delivery

• Low birth weight

• Stillbirth

• Breathing difficulties in the newborn