Preeclampsia is a condition that exclusively develops in pregnant women. Here, high blood pressure is seen along with an abnormally high quantity of protein in the urine. If untreated, it can lead to eclampsia. This is a potential life threatening condition where seizures occur and affects both the mother and the baby. The cause of preeclampsia is not unknown. Common symptoms include weight gain, dizziness, fever, edema, decreasing frequency of urination etc. The most accepted method of dealing with severe eclampsia is to deliver the baby. In mild cases, medicines and rests are prescribed.
Preeclampsia and eclampsia were previously called toxemia in pregnancy. This is an unexplained condition where high blood pressure and excess protein in the urine is noticed. It can eventually lead to several complications for you and your baby and they may even prove fatal. Treatment of preeclampsia is always a challenge. It is the leading cause of illness and deaths in mothers and babies. According to conservative estimates, disorders caused by preeclampsia are responsible for 76000 deaths every year. Eclampsia which can develop later is the second leading cause of maternal death in USA.
Understanding the dimension of the problem
Here are some data and statistics which will help to make it clear how serious and prevalent the condition of preeclampsia is:
|Place of incidence||Rate of incidence|
|World||2% to 10%|
|Developed countries||0.4% of live births|
|Developing countries||2.8% of live births|
|North America and Europe||5 to 7 cases per 10000 deliveries|
|South Africa, Egypt, Tanzania, Ethiopia||1.8% to 7.1%|
|Nigeria||2% to 16.7%|
Source: The World Health Report, 2005. World Health Organization
Hospital statistics from UK showed that in 2002-03, 0.013% of all hospital consultation episodes in pregnancy were concerned with hypertension and high protein in urine. These and other data show that preeclampsia continues to be one of the major complications that may develop during a pregnancy.
Risks and causes of preeclampsia
The exact cause of preeclampsia is not known, though several risk factors have been identified. This condition is exclusive to pregnancy and generally develops after 20 weeks of gestation, i.e. in the late second trimester or during the third trimester.
In this condition, the placenta develops certain abnormalities. There is some speculation that poor diet, a compromised immune system or poor flow of blood to the uterus can cause preeclampsia. Coagulation abnormalities and abnormal behavior of the maternal blood vessels are observed in this condition. They lead to a decreased perfusion of the placenta. However, this second stage does not necessarily follow on the foot of the first and the link between the two is not clear.
Certain risk factors have been identified which presents a greater probability for development of preeclampsia. These are as follows:
- Women who have a near female blood relative with history of preeclampsia are at greater risk. So, if your mother or sister developed this condition, you have a greater chance of developing this problem.
- In general, the risk is highest in the first pregnancy. It is also high if you are carrying multiple fetuses.
- Risk of preeclampsia is high for mothers aged below 20 or above 40.
- Too long an interval between successive pregnancies may be another risk factor.
- Gestation diabetes and gestational hypertension often occur along with this problem. In fact, preeclampsia develops as a byproduct of these problems.
- History of autoimmune disorder, periodontal disease during pregnancy, insufficient supply of vitamin D, kidney disease, scleroderma, lupus or rheumatoid arthritis increases the risk of preeclampsia.
- Obese women are at greater risk.
- Poor diet may also play a role. In this condition, certain proteins increase in the blood. Proteins play a key role in development of tissues. So, undue concentration of certain proteins can lead to abnormal development of the blood vessels leading to preeclampsia.
Signs and symptoms of preeclampsia
The signs of preeclampsia are seen about 20 weeks into the pregnancy, though it may develop later. The common signs are as follows:
- Severe headaches, dizziness and a buzzing sound in the ear is one of the earliest symptoms of preeclampsia.
- There may occur sudden changes in vision which may be as intense as sudden blindness. You may experience double vision or blurred vision.
- Pain occurs in the upper right side of the abdomen near the ribs.
- High blood pressure is the most important symptom of preeclampsia. If the systolic pressure is more than 140 and the diastolic is more than 90 or both, then this is a strong indication of the condition. A blood pressure of 160/110 is considered to be severe preeclampsia. However, you should remember that pregnancy induced hypertension is not the same as preeclampsia and those who have the former does not necessarily develop the latter.
- The high blood pressure manifests itself through edema or excessive swelling. Some amount of swelling of extremities is common in pregnancy. But in preeclampsia, the degree of swelling is markedly higher. Facial swelling is also noticed.
- Agitation, palpitation and rapid heartbeat are also common.
- One of the risk factors of preeclampsia is obesity and one of its symptoms is sudden weight gain. If you gain more than 2 pounds per week or experience sudden onset of weight gain within a day or two, this is a serious indication of preeclampsia.
- The amount of urine will decrease to such an extent that there may be no urination at all. The level of protein increases in the urine and the functioning of the kidney is affected.
All the above signs except high protein in the urine are common in pregnancy. Hence, it is difficult to identify when it is a complication of pregnancy or when it is preeclampsia. So, a few diagnostic tests are required to confirm that you do have preeclampsia.
Diagnosis of preeclampsia
If you have many of the above symptoms, you should at once consult your doctors. Here are some of the diagnostic tests used in confirming the condition:
- The weight is taken and the history of weight gain is documented. Sudden gain of significant amount of weight is one of the criteria.
- Blood pressure is taken repeatedly at the interval of six hours. If persistent high values as described above are recorded, this is pregnancy induced hypertension.
- The amount of urine and the protein level in the urine is tested. If more than 300 mg of protein is detected in total urine over 24 hours, this is proteinuria.
- The platelet count is taken. If this is less than 100000, then this is another confirming sign.
- Liver function tests reveal elevated levels.
Treatment and prevention of Preeclampsia
Preeclampsia prevents the placenta from carrying enough nutrition and oxygen to the baby, leading to several problems. In some cases, it may lead to eclampsia. These are seizures which may prove fatal to the mother and the baby.
The various treatment options are as follows:
- The only effective cure for preeclampsia is to deliver the baby. If you are 37 weeks or more along, the doctor may induce labor or may perform a caesarean section to deliver the baby. If your pregnancy is less than 24 weeks along, a C-section may be the only treatment of choice though the chances of survival of the fetus are very small.
- If you develop mild preeclampsia after 20 weeks, the doctor may try to prolong your pregnancy to allow the baby to mature. Bed rest may be prescribed. The fetal heart rate, the blood pressure of the mother and the amount of urine in the protein is monitored carefully and frequently.
- The period between 24 and 34 weeks of gestation is the grey period when each case is evaluated by itself to decide on the treatment.
- If the doctor decides to delay the delivery of the baby, the mother may be given magnesium injection to prevent seizures related to eclampsia.
- Oral medicines are also given to lower the risk of seizures. Fluid intake is monitored and the mother receives steroid injection to help develop the various organs of the baby – especially the lungs. This will help the chances of survival of the baby if an emergency delivery has to be done.
Delaying delivery has generally not resulted in any benefits. Instead it has lead to several complications. After the delivery, the symptoms of preeclampsia should disappear within 1 and 6 weeks. If it persists, it is called post partum eclampsia and can be dangerous to maternal health as the symptoms are often ignored as after effects of pregnancy.