Pre-eclampsia in pregnancy-Causes and Treatment

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Pre-eclampsia is not uncommon in pregnant women and is caused due to high blood pressure during pregnancy. In pre-eclampsia there is a sudden, sharp rise in the blood pressure to more than 140/90 mmHg along with swelling of the face, hands and feet. The urine shows the presence of protein or albuminuria. This condition is called pre-eclampsia or toxaemia of pregnancy.

Pre-eclampsia is the most common pregnancy related complication and it generally develops in about 1 in 200 pregnant women, usually after 20 weeks of gestation. There may be no symptoms and the condition may be diagnosed during a routine prenatal check up.

Can't be cured but can be controlled

There is no cure for pre-eclampsia but it must be monitored carefully as it may lead to eclampsia, a potentially life threatening condition in which seizures occur in the mother and can cause the death of either/or mother and baby.

During the seizure or convulsion, in eclampsia, the mother's arms, legs, neck or jaw will twitch involuntarily in repetitive, jerky movements for about a minute or so. She may lose consciousness and may wet herself.

While most women make a full recovery after having eclampsia, there's a small risk of permanent disability or brain damage if the fits are severe. Of those who have eclampsia, around 1 in 50 will die from the condition. Unborn babies can suffocate during a seizure and die.

What causes pre-eclampsia?

The exact causes of pre-eclampsia and eclampsia are not understood very well. It is most likely due to a placenta that doesn't function properly possibly due to insufficient blood flow to the uterus. Poor nutrition or high body fat could also be possible causes. Genetics plays a role, as well.

The mother's blood supply links to the unborn baby is via the placenta. All the baby's oxygen and nutritional requirements travel through the placenta.

It is presumed that insufficiently formed placental blood vessels or villi cause inefficiency of the placenta. The extra blood supply that should be traveling from mother to child does not get through; this causes hypertension, swelling, and possibly kidney problems. The mother also cannot eliminate waste products fast enough, and they build up in her blood, causing proteinuria.

Preeclampsia is most often seen in first-time pregnancies. It is more common in teenage mothers and in women over the age of 40.

There is an increased likelihood of developing pre-eclampsia if-

  • there is a history of high blood pressure prior to pregnancy,
  • preeclampsia occurred in a previous pregnancy,
  • history of pre-eclampsia runs in the family,
  • the mother is obese, or has diabetes, kidney disease,
  • the expectant mother has a sister or mother who had pre-eclampsia
  • it is a multiple pregnancy
  • It's been10 years since the last pregnancy

Pre-eclampsia and related symptoms-

Apart from swelling of the face, hands and feet, the mother may experience a sudden weight gain due to increase of fluids in the body, she may suffer from headaches, which could be severe, and see flashing lights or notice blurry vision or other vision changes. There may be reduced urine output, dizziness, nausea and vomiting. There may also be pain in the abdomen usually on the right side just under the ribs.

Although many cases of pre-eclampsia are mild, the condition can lead to serious complications for both mother and baby if it's not monitored and treated.

The risks of untreated pre-eclampsia include stroke and seizures in the mother. The eyes can suffer temporary blindness, the heart can  fail and the lungs can fill with fluids. There could be bleeding from the liver as well as  bleeding after delivery. There is also an increased risk of placental separation or abruption.

Pre-eclampsia in the mother can have some long-term consequences for the developing baby. The condition can cause the baby to be born very small because of poor growth as it's placenta receives a restricted blood flow. It is also one of the leading causes of premature births, and the complications that can follow, such as learning disabilities, epilepsy, cerebral palsy, hearing and vision problems. There is also the risk of stillbirth.

The earlier the diagnosis of pre-eclampsia, the better the outlook for mother and baby.

The only cure for pre-eclampsia and eclampsia is to deliver the baby. Depending upon the stage of pregnancy and how well the baby is doing, the doctor may opt to induce labor or perform a cesarean section. This is usually done after 37 weeks when the baby has had the chance to develop fully.

If the pregnancy is not close to term, the doctor may be able to treat pre-eclampsia until the baby has developed enough to be safely delivered. The closer the birth is to the due date, the safer for the  baby.

If the pre-eclampsia is mild without severe features, the doctor may prescribe:

  • Bed rest either at home or in the hospital; the mother will be asked to rest mostly on her left side.
  • Careful observation of the foetal heart rate and frequent ultrasounds
  • Medicines to lower the blood pressure such as hydralazine
  • Blood and urine tests
  • Monitoring of fluid intake and urine output
  • Medicine to help prevent seizures, such as I/V magnesium sulfate
  • Steroid injections to help the baby's lungs develop more quickly

If the pre-eclampsia is severe, the doctor may need to deliver the baby right away, even if the pregnancy is not close to term.

After delivery, the signs and symptoms of pre-eclampsia usually go away within 1 to 6 weeks.

Source: Preeclampsia: Causes, symptoms, and treatments

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