Preeclampsia
Preeclampsia is a pregnancy disorder that can have devastating effects on the health of the mother and the unborn baby. Affecting 5-8% of all pregnancies, it's a rapidly progressive and potentially deadly condition.
The UK’s National Health Service (NHS) gives a good overview of the symptoms and cause of preeclampsia:
Symptoms
The key symptoms of preeclampsia are persistent high blood pressure and an excess of protein in the urine. This can be accompanied by severe headaches, blurred vision, and sensitivity to light. Women with preeclampsia may also experience swelling, particularly in the hands, feet, and face, which is often accompanied by sudden weight gain. Other symptoms include abdominal pain, nausea or vomiting, and in some cased shortness of breath.
It is important to note that some women may not experience any noticeable symptoms, making regular prenatal check-ups crucial for early detection and management of preeclampsia. If left untreated, preeclampsia can lead to deadly complications for both the mother and the baby, so seeking medical advice is essential.
Cause
Pre-eclampsia is thought to be caused by the placenta not developing properly due to a problem with the blood vessels supplying it. The exact cause isn't fully understood.
The Placenta
The placenta links the mother's blood supply to her unborn baby's blood supply. Food and oxygen pass through it from the mother to the baby. Waste products also pass from the baby back into the mother. To support the growing baby, the placenta needs a large and constant supply of blood from the mother. In pre-eclampsia, the placenta doesn't get enough blood. This could be because the placenta didn't develop properly as it formed during the first half of the pregnancy. The problem with the placenta means the blood supply between mother and baby is disrupted. Signals or substances from the damaged placenta affect the mother's blood vessels, causing high blood pressure (hypertension). At the same time, problems in the kidneys may cause important proteins that should remain in the mother's blood to leak into her urine, resulting in protein in the urine (proteinuria).
What causes problems with the placenta?
In the initial stages of pregnancy, the fertilised egg implants itself into the wall of the womb (uterus). The fertilised egg produces root-like growths called villi, which help to anchor it to the lining of the womb. The villi are fed nutrients through blood vessels in the womb and eventually grow into the placenta. During the early stages of pregnancy, these blood vessels change shape and become wider. If the blood vessels don't fully transform, it's likely that the placenta won't develop properly because it won't get enough nutrients. This may lead to pre-eclampsia. It's still unclear why the blood vessels don't transform as they should. It's likely that inherited changes in your genes have some sort of role, as the condition often runs in families. But this only explains some cases.
Who's most at risk?
Some factors have been identified that could increase your chances of developing pre-eclampsia. These are:
-
having an existing medical problem – such as diabetes, kidney disease, high blood pressure, lupus or antiphospholipid syndrome
-
previously having pre-eclampsia
-
Some factors also increase your chances by a small amount. However, if you have 2 or more of these together, your chances are higher. These include:
-
It’s your first pregnancy – pre-eclampsia is more likely to happen during the first pregnancy than during any subsequent pregnancies.
-
It's been at least 10 years since your last pregnancy.
-
You have a family history of the condition – for example, your mother or sister has had pre-eclampsia.
-
You're over the age of 40.
-
You were obese at the start of your pregnancy – meaning you had a body mass index (BMI) of 35 or more.
-
You're expecting twins or more.
-
If you are pregnant and worried about your risk of preeclampsia or other hypertensive disorders talk to your healthcare provider. They are best placed to advise you on your personal diagnostics and monitoring needs.
Diagnosis
Diagnosing preeclampsia typically involves a combination of medical history assessment, physical examination, and various tests during pregnancy check-ups:
-
Monitoring blood pressure
-
Test for presence of proteinuria
-
Ultrasound to examine placental blood flow and fetal well-being
Accurate and timely diagnosis is crucial for appropriate management and to minimize potential risks to both the mother and the baby. Therefore, it is important for pregnant individuals to attend regular prenatal visits and communicate any concerning symptoms to their healthcare provider.
Recent blood tests for the proteins PlGF (placental growth factor) and sFlt-1 (soluble fms-like tyrosine kinase-1) are fast becoming the gold standard for the diagnosis of preeclampsia (1, 2, 3, 4)
PlGF is a protein produced by the placenta that promotes healthy blood vessel growth, while sFlt-1 is a protein that can interfere with normal blood vessel function when it is present in excessive amounts. By measuring the levels of these biomarkers in the blood, healthcare providers can gain valuable insights into the development and severity of preeclampsia. A decrease in PlGF levels and an increase in sFlt-1 levels are often observed in women with preeclampsia. These blood tests can help differentiate preeclampsia from other pregnancy-related conditions and may assist in determining the appropriate management and timing of delivery. The utilization of PlGF and sFlt-1 testing enhances the accuracy of preeclampsia diagnosis, leading to better risk assessment and improved outcomes for both the mother and the baby.
Treatment
The guidelines for the treatment of preeclampsia vary from country to country. See Here (https://www.preeclampsia.org/current-guidelines) for the current guidelines from a variety of healthcare organizations.
The US-based Mayo Clinic breaks down the options for treatment into low and high severity:
The primary treatment for preeclampsia is either to deliver the baby or manage the condition until the best time to deliver the baby. This decision will be made with your health care provider and will depend on the severity of preeclampsia, the gestational age of your baby, and the overall health of you and your baby.
Treatment / Monitoring of low severity preeclampsia:
If preeclampsia isn't severe, you may have frequent checkups to monitor your blood pressure, any changes in signs or symptoms, and the health of your baby. You'll likely be asked to check your blood pressure daily at home.
If preeclampsia is diagnosed before week 14 (early onset preeclampsia) low dose aspirin treatment has been shown to be highly effective in reducing the effects of preeclampsia.
Treatment of severe preeclampsia
Severe preeclampsia requires that you be in the hospital to monitor your blood pressure and possible complications. Your health care provider will frequently monitor the growth and well-being of your baby. Medications to treat severe preeclampsia usually include:
-
Antihypertensive drugs to lower blood pressure.
-
Low dose Aspirin
-
Anticonvulsant medication, such as magnesium sulfate, to prevent seizures
-
Corticosteroids to promote development of your baby's lungs before delivery
-
Delivery
-
If you have preeclampsia that isn't severe, your health care provider may recommend preterm delivery after 37 weeks. If you have severe preeclampsia, your health care provider will likely recommend delivery before 37 weeks, depending on the severity of complications and the health and readiness of the baby.
-
The method of delivery — vaginal or cesarean — depends on the severity of disease, gestational age of the baby and other considerations you would discuss with your health care provider.
After delivery
You need to be closely monitored for high blood pressure and other signs of preeclampsia after delivery. Before you go home, you'll be instructed when to seek medical care if you have signs of postpartum preeclampsia, such as severe headaches, vision changes, severe belly pain, nausea and vomiting.
Source (https://www.mayoclinic.org/diseases-conditions/preeclampsia/diagnosis-treatment/drc-20355751)
For Further information on preeclampsia and other hypertensive disorders in pregnancy please check out the following links: