Preeclampsia
What is preeclampsia?
Preeclampsia is diagnosed when you have high blood pressure during pregnancy ≥140 / 90mm Hg with protein in your urine after 20 weeks of pregnancy. It is possible to develop it before 20 weeks but it is rare for e.g in molar pregnancy.
What causes preeclampsia?
Even though a lot of research has been done on preeclampsia, the exact cause still remains a mystery. One of the theory state that preeclampsia may develop due to problems during implantation of the embryo. The arteries which supply the placenta do not dilate and relax but remain constricted. Why this happens in some women and not the others remains unknown.
Who is at increased risk of developing preeclampsia?
- First baby at the age of less than 20 or more than 35 years old.
- Carrying twins or more
- Known history of diabetes, chronic hypertension, kidney or autoimmunie disorders
- History of preeclampsia in previous pregnancy
- Family history (close relative) with history of preeclampsia
- Overweight or obese
- First pregnancy with new partner
What are the complications associated with preeclampsia during pregnancy?
The more severe and earlier onset the preeclampsia occurs the more possible complications could occur to you and your baby. Preeclampsia could cause constriction of your blood vessels with reduced blood flow to your organs such as the liver, kidney and brain leading to damage. Other potential complication includes placenta abruption, HELLP syndrome and eclampsia. Reduced blood flow could also occur within the placenta leading to growth restriction of your baby and little amniotic fluid (oligohydramnios). Severe growth restriction could cause distress in the baby and even death.
What is HELLP syndrome?
Some women with preeclampsia develops HELLP syndrome. HELLP syndrome stands for Hemolysis (breakdown of red blood cells), Elevated Liver enzymes and Low Platelet (blood cells responsible for clotting) This would put you and your baby at higher risk of the complications associated with severe preeclampsia.
What is eclampsia?
Eclampsia is a life-threatening condition and occurs in about 1 in 2000 (0.05%) pregnancies. In this condition, seizures or fits occurs. These are like epileptic fits. Other complications could also occur for example kidney, lung, liver failure and HELLP syndrome. The seizures may be preceded by symptoms of impending eclampsia such as headaches, blurring of vision, nausea, vomiting, severe upper abdominal pain or confusion. However, in some women there are no preceeding warning symptoms before the seizure occurs. Magnesium sulphate is an effective medication to prevent and treat eclampsia.
When should I call and see the doctor?
- Swelling or puffiness on your face and around your eyes.
- Excessive or sudden swelling of your feet and ankles.
- Headache
- Nausea and vomiting (other than due to morning sickness in the first trimester)
- Blurring of vision
- Upper abdominal pain (especially if severe)
- Reduced fetal movement
- Bleeding vaginally
What is the treatment for preeclampsia?
The ultimate treatment for preeclampsia is delivery of your baby and the placenta. However, this will depend on the severity of the preeclampsia and how far along you are in your pregnancy. Some of the possible treatments which will be given include:
- Anti-hypertensive medication to control your blood pressure.
- Magnesium sulphate to prevent and treat any eclampsia
- Corticosteroids i.e Dexamethasone intra-muscularly especially if you are less than 34 weeks to help your baby’s lungs mature quickly in case earlier delivery is required. If your baby delivers prematurely, the lungs will also be premature causing difficulty in breathing. Your baby may need a ventilator.
- Early delivery (premature delivery) In most cases will be through caesarean section
If your blood pressure is well controlled and your baby is growing well, you may monitor closely up till 37 – 38 weeks and then aim for delivery.
Are there any way of avoiding myself from getting preeclampsia?
No one knows exactly how to prevent preeclampsia even though extensive research is currently being done in this area. Several findings are listed as below:
- Calcium supplement.
Studies have shown that preeclampsia is significantly reduced in women who take calcium supplement. However, this only applies in women who has low calcium intake in their diet.
- Vitamin E and C.
A few older small studies suggest that taking vitamin E and C reduces the risk of preeclampsia. However, recent larger study contradicts this finding and in fact may be associated with other complications
- Aspirin.
There has been some studies showing that taking aspirin early in pregnancy could reduce the risk of preeclampsia in women at higher risk of developing it (e.g kidney disease, severe diabetes, previous preeclampsia in previous pregnancy, chronic hypertension)
If I have preeclampsia in the previous pregnancy, will I get it in the next pregnancy?
Yes, there is an increased risk of getting preeclampsia in your next pregnancy up to 20%.
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