Preeclampsia

What is Preeclampsia?

Hypertensive disorders, or high blood pressure conditions that happen during pregnancy, are some of the main reasons for deaths of mothers and babies globally. Preeclampsia is a particular high blood pressure condition that starts during pregnancy and often becomes evident after 20 weeks of pregnancy. It can sometimes come with severe features and lead to more dangerous conditions like eclampsia and HELLP syndrome. It’s common, making up 2% to 8% of pregnancy-related complications, and is linked to over 50,000 maternal deaths and over 500,000 fetal deaths every year across the world. To stop these unfortunate events from happening, it’s extremely important to diagnose it early and manage it properly through symptom control and planning for the delivery of the baby.

Preeclampsia can first be caught when the blood pressure of the expecting mother reaches a “mild range” blood pressure. This is defined by systolic blood pressure (the top number in a blood pressure reading) that is 140 mm Hg or higher, or diastolic blood pressure (the bottom number) that is 90 mm Hg or higher. These numbers should be seen on two occasions at least four hours apart or in a shorter period of time if the blood pressure is in the “severe range,” meaning a SBP of 160 mm Hg or higher or a DBP of 110 mm Hg or higher. These blood pressure figures should be recorded after 20 weeks of gestation, which indicates they are due to pregnancy. If high blood pressure is detected before 20 weeks, this is identified as “chronic hypertension,” or high blood pressure that was present before pregnancy.

Preeclampsia typically first shows up in pregnancies near term, or close to the due date. We understand this form of hypertension to start with gestational hypertension, which is high blood pressure that begins during pregnancy and then progresses to more severe forms of high blood pressure. Despite our growing understanding of this condition, it’s important to note that the way we define it isn’t based on primary research but on collective agreement and expert opinion from prestigious bodies like the American College of Obstetrics and Gynecology (ACOG). In the past, preeclampsia was defined by three main symptoms: high blood pressure, swelling (edema), and protein in the urine. Now, it mainly has to do with high blood pressure and trouble with certain organs like the kidneys, liver, brain, blood, or the placenta (the organ that nourishes the fetus).

What Causes Preeclampsia?

Even though doctors understand a lot about how to recognize and treat preeclampsia, a condition that can occur during pregnancy, it’s still not totally clear what causes it. The main idea behind what causes this condition involves the placenta (the organ that gives your baby nutrients and oxygen while you’re pregnant) not getting enough blood. This idea comes from observations of signs of the placenta not getting enough blood in patients who have had eclampsia (a more severe form of preeclampsia that includes seizures), and experiments with animals.

The process behind preeclampsia may be similar to what happens with certain toxins in the body – they cause widespread problems to blood vessels. If this continues, it can lead to severe complications like seizures, known as eclampsia.

Scientists have studied this idea a lot and there are several lines of evidence that support it:

• Experiments that deliberately block blood flow in animals leads to high blood pressure and protein in the urine, which are signs of preeclampsia.
• Pregnant women with preeclampsia have less blood flow to the uterus (where your baby grows during pregnancy) compared to pregnant women without preeclampsia.
• Examination of the placenta in women with preeclampsia or eclampsia often shows signs of insufficient blood supply.
• Failure of typical changes to certain arteries and placental blood vessels are common in preeclampsia.
• A measurement of blood flow in the uterine artery often shows that there’s higher resistance in women with preeclampsia than in women who have normal pregnancies.

While most experts agree that lack of blood supply to the placenta probably plays a big role in causing preeclampsia, more research is needed to understand this process better.

Risk Factors and Frequency for Preeclampsia

Preeclampsia and eclampsia, which are types of high blood pressure disorders during pregnancy, cause over 50,000 maternal deaths every year worldwide. In particular, black and Hispanic people are most likely to be affected by preeclampsia, leading to about 26% of maternal deaths in these communities in the United States. Overall, preeclampsia affects 2% to 8% of pregnancies worldwide, but these rates vary depending on race and location, and it tends to be more severe in developing countries, especially in Africa and Latin America. On the other hand, it seems less common among Asian populations, including those in China and New Zealand, as well as Asian Americans compared to Native Americans, African Americans, and Europeans.

There are also many factors that might increase the risk of developing preeclampsia:

• Having high blood pressure, diabetes, kidney disease, or autoimmune disorders like lupus or antiphospholipid antibody syndrome
• Being obese, short, or malnourished
• Having hypertension in a previous pregnancy
• Inheriting the likelihood from family
• Having a type of pregnancy complication known as a molar pregnancy
• Having more than one baby at a time
• Having a large baby
• Being pregnant for the first time
• Being older
• Having a high Body Mass Index (BMI)
• Using assisted reproductive technology to get pregnant

Signs and Symptoms of Preeclampsia

Preeclampsia is a medical condition that usually affects pregnant women. Even though it typically has clear symptoms and signs, it can sometimes present differently. It’s essential to understand the common signs of preeclampsia because it will prompt further tests and treatment if needed.

Usually, patients with preeclampsia report a new type of headache that is not relieved by medication and is different than any previous headaches or migraines they have experienced. Sometimes, there are also problems with vision. Patients may also feel pain in the upper right area of their belly or experience nausea and vomiting. There might be also shortness of breath and a noticeable increase in swelling, which is more severe than the usual swelling during pregnancy.

Anyone having these symptoms during pregnancy should have an in-depth checkup. The doctor will start by checking vital signs, especially blood pressure. Blood pressure that is 140/90 mmHg or higher raises concern for preeclampsia. In patients at 20 weeks of pregnancy or later, blood pressure should be measured twice at least four hours apart for accurate evaluation.

Doctors now consider persistently high blood pressure readings even within a few minutes of rechecking. If the blood pressure reaches or surpasses 160/110 mmHg, immediate treatment for high blood pressure might be necessary. According to the American Congress of Obstetricians and Gynecologists, patients previously diagnosed with pregnancy-induced hypertension that have these high blood pressure readings should be diagnosed with severe preeclampsia, independent of the presence of other diagnostic criteria.

If a patient also experiences shortness of breath, examination of the lungs may be necessary. The doctor may also check if there is discomfort in the upper right part of the belly. Part of the check can also include looking for edema or swelling, particularly in the lower legs, face, or hands.

• New type of headache not relieved by medication
• Vision disturbances
• Pain in the upper right area of the belly
• Nausea and vomiting
• Shortness of breath
• Increase in swelling more than usual pregnancy-related symptoms
• Blood pressure reaching or surpassing 140/90 mmHg
• Blood pressure reaching or surpassing 160/110 mmHg, requiring immediate treatment.

Testing for Preeclampsia

If you’re showing signs and symptoms of preeclampsia, your doctor will first talk to you about your medical history and do a physical check-up. They will then carry out several tests to confirm the diagnosis. Preeclampsia is a condition that can occur during pregnancy, leading to high blood pressure and damage to organs like the liver and kidneys.

First of all, a urinalysis is done. This checks for the presence of proteins in the urine (proteinuria). These proteins can show up if your kidneys aren’t functioning properly. The doctor may either use a urine dipstick test (and look for a result of 2+ or more), or they might collect your urine over a 24-hour period and examine the sample for more than 300 mg of protein. Another method involves comparing the levels of protein and creatinine (a waste product) in a single urine sample, looking for a ratio greater than 0.3.

Next, a complete blood count test is carried out. This checks for a low number of platelets (thrombocytopenia), which are the cells that help your blood clot. If there are fewer than 100,000 platelets per cubic millimeter (K/mm) of blood, it is a cause for concern.

The doctor will also perform a complete metabolic panel test. This assesses if the liver is working fine, by checking if the liver enzymes (substances that speed up chemical reactions) are more than twice the normal upper limit. The test also looks for signs of kidney insufficiency; if the concentration of serum creatinine (a waste product that should be filtered out by your kidneys) in your blood is 1.1 mg/dL or more, or it’s double your baseline value, then your kidneys might not be working properly.

It’s important to note that any unusual results from these tests have to be new findings (i.e., not due to pre-existing conditions or other causes) to be significant for diagnosing preeclampsia.

Typically, a diagnosis of preeclampsia is made if you have high blood pressure and proteins are found in your urine. However, in some cases, you might not have proteinuria but still have preeclampsia. That’s why other new symptoms are monitored, like a low platelet count, kidney problems, build-up of fluid in the lungs (pulmonary edema), liver problems, or a new headache with or without vision problems. If these symptoms are present along with new, high blood pressure readings (systolic blood pressure of 160 mmHg or more, or diastolic blood pressure of 110 or more measured at least 4 hours apart twice), the condition is diagnosed as preeclampsia without severe features.

Treatment Options for Preeclampsia

Preeclampsia is a condition that occurs during pregnancy, where a mother-to-be has high blood pressure and potential damage to organs. It’s very important to diagnose this condition early and start treatment to make sure the mother and baby are safe.

There are two main goals in treating preeclampsia: controlling blood pressure and preventing seizures. High blood pressure is a severe concern during pregnancy, with pressure greater than or equal to 160/110 mm Hg being especially worrisome. The treatment depends on how far along the pregnancy is and how severe the preeclampsia is.

There are several medications that can be used to lower blood pressure that won’t harm the baby include beta-blockers (like labetalol), calcium-channel blockers (like nifedipine), alpha-2 agonists (like clonidine), and vasodilators (like hydralazine). The choice of medication will depend on different factors such as availability and any prior health conditions.

It’s also crucial to prevent seizures (a severe complication of preeclampsia) in mothers-to-be with severe features of preeclampsia. The first choice for this is an IV medication called magnesium sulfate. However, if magnesium sulfate is not a good option, another medication, levetiracetam, can be used instead. If seizures do occur, they can be treated with a medication group called benzodiazepines. Other medications are available if seizures continue despite initial treatment.

While managing this condition, the health of the baby needs to be monitored. This includes checks on the amount of fluid around the baby, the baby’s weight, and how well the baby is doing overall. The baby’s health can also influence the decision between delivering the baby early or watching and waiting – this is known as expectant management.

Ultimately, the only real cure for preeclampsia is to deliver the baby. For less severe cases where the baby is not in immediate danger, the doctors might decide to monitor both the mother and the baby closely, which could include additional ultrasound exams, checks of the mother’s blood pressure and other laboratory tests. In these cases, doctors might recommend having the baby at around 37 weeks.

In more severe cases, however, doctors might recommend having the baby as soon as the mother’s health has been stabilized, even if the baby is less than 34 weeks along. In these scenarios, the doctors will do their best to improve both the mother’s and the baby’s health before the delivery. However, if the mother’s or baby’s health worsens, the doctors may need to deliver the baby as soon as possible, regardless of how far along the pregnancy is.

This is a complex situation and involves lots of decisions. So, it is essential for doctors and healthcare providers to discuss with the patient all the benefits and risks associated with each decision. With good care, both mother and baby should be fine.

What else can Preeclampsia be?

When a doctor is trying to diagnose preeclampsia, they also need to consider if the patient might have other conditions instead. These could include:

• Chronic high blood pressure
• High blood pressure during pregnancy
• Antiphospholipid antibody syndrome (a disorder of the immune system)
• Thrombotic microangiopathies (disorder of the small blood vessels)
• Lupus (an autoimmune disease)
• Epilepsy or other seizure disorders
• Chronic kidney disease
• Chronic liver disease
• Pheochromocytoma (a rare tumour of the adrenal gland)
• Other endocrinopathies (hormonal disorders)

It is crucial for the doctor to weigh these possibilities in order to make the correct diagnosis.

What to expect with Preeclampsia

Identifying health problems early, getting the right medical help quickly, and keeping a close watch on both mother and baby’s health can greatly improve the health outcomes for both. Preeclampsia, a condition that can occur during pregnancy, is responsible for nearly a quarter of maternal deaths among certain ethnic groups, including those from the Caribbean, Latin America, Asia, and the black community. Getting care quickly and having regular health check-ups can help reduce the risk of complications and increase the chances of survival.

Possible Complications When Diagnosed with Preeclampsia

: If a baby isn’t delivered promptly in late preterm mothers suffering from preeclampsia, there’s a greater risk of severe high blood pressure. This can lead to severe conditions like eclampsia, HELLP syndrome, fluid in the lungs, heart attack, serious breathing difficulties, stroke, kidney and eye damage, and complications for the baby. These can include issues with the baby’s growth, the placenta partially or completely separating from the inner uterine wall (placental abruption), or even the death of the baby or mother.

• Eclampsia
• HELLP syndrome
• Fluid in the lungs
• Heart attack
• Serious breathing difficulties
• Stroke
• Kidney and eye damage
• Issues with the baby’s growth
• Placental abruption
• Potential death of the baby or mother

Starting medical treatment to manage blood pressure can also result in complications like a faster heart rate, low blood pressure, headaches, and abnormal heart rhythms in the baby. This can happen when using medications like labetalol, hydralazine, or nifedipine. Using magnesium sulfate to prevent seizures can also have negative effects such as breathing difficulties and even a heart attack. Therefore, regular check-ups every 4 to 6 hours and periodic lab testing of blood magnesium levels are recommended for patients on magnesium sulfate therapy.

Preventing Preeclampsia

Catching a condition called preeclampsia early, managing it correctly, and keeping a close watch on it are all crucial steps in lowering the chances of harm or even death for both the mother and unborn baby. A key part of this is making sure patients understand their condition and any unique factors that may make it harder for them to receive proper treatment. This means doctors need to clearly explain to their patients what preeclampsia is, the warning signs to look out for, and anything specific to the patient that could put them at a higher risk.

Preeclampsia can be more fatal for mothers who come from lower socio-economic backgrounds or who have less education. That’s why it’s so important for health care professionals to understand the unique needs and characteristics of the community they’re serving. They should build strong relationships with patients who are at high risk for preeclampsia and adapt complicated medical information to suit each patient’s level of understanding.