Preeclampsia is one of the major causes of death in pregnant women. This is evident in developing and developed countries. Many pregnancies worldwide is affected by preeclampsia.
Content of this article
- Diagnosis of preeclampsia
- Treatment of preeclampsia
- prevention of preeclampsia
- complications of preeclampsia
Preeclampsia is the presence of high blood pressure in a woman that has a normal blood pressure after 20 weeks of gestation with presence of protein in urine.
The risk factors, causes and symptoms of preeclampsia is outlined in this article.
Diagnosis Of Preeclampsia
The major symptoms of preeclampsia do not show up in mild disease. Pregnant women with mild diseases show vague like symptoms. This is ignored by most pregnant women.
But as your blood pressure continue to rise, you will notice some of these symptoms.
- Visual disturbances or blurring of vision
- Upper abdominal pain or epigastric pain. This may also extend or radiate to the right upper abdomen.
- Increase restlessness
- weight gain
- Swelling of the ankle, hand and face. It is normal for pregnant women to develop swelling in pregnancy. However, swelling of the hand and face should require visit to your doctor.
There are two types of preeclampsia. The mild and severe types of preeclampsia.
How to diagnose mild preeclampsia in pregnancy
Mild preeclampsia is discovered as a routine check during clinic visits. Most patients show little or no symptoms.
To diagnosed mild preeclampsia
- You are not a known hypertensive patient. This means your blood pressure is normal before your pregnancy.
- You developed hypertension after 20 weeks or 5 months of pregnancy. The systolic blood pressure is atleast 140mmHg but not greater than 159mmHg. Also the diastolic Blood pressure is atleast 90 mmHg or but not greater than 109mmHg.
- There is presence of protein in urine that is significant. Presence of 300mg or more of protein in urine sample after 24 hours sample is significant. In centers where a dipstick urine test is done, the presence of ≥1+ urine is significant. The function of the kidneys is to eliminate waste. It is abnormal for the kidneys to filter protein in urine in large amount.
- There is an increase in protein creatinine ratio >30mg/mol.
- Your blood pressure normalizes within 6 weeks of delivery.
Blood pressure is the pressure of your blood against blood vessels. It is routinely checked during your antenatal clinic visits. If your blood pressure is high, you will be informed. Your doctor will counsel you on the challenges and pregnancy outcomes.
Urine test is done either by use of a dipstick test or by collecting urine samples over 24 hours for analysis. If there is abnormality with your urine, you are informed and counselled by your doctor too.
Diagnosis Of Severe Preeclampsia
Severe preeclampsia is easily diagnosed. This is because most patients with severe preeclampsia show symptoms. Some common symptoms include headache and abdominal pain.
To diagnose severe preeclampsia
- You have no history of hypertension before 20 weeks of pregnancy.
- You develop high blood pressure after 20 weeks or 5 months of pregnany. Systolic blood pressure is atleast 160mmHg and the diastolic blood pressure is atleast 110mmHg.
- There is large amounts of protein in urine ranging from 1+ to 3+ urine dipstick test. Sometime more than 5g in 24 hours urine sample analysis. The amount of protein in urine does not always correspond to severity of the disease.
- Your blood pressure returns to normal within 6 weeks after delivery.
Preeclampsia can also be diagnosed in patients that already has hypertension before pregnancy. The presence of high blood pressure in pregnant women before and during pregnancy is chronic hypertension.
For these patients with chronic hypertension, Preeclampsia is diagnosed as the increase in the systolic blood pressure ≥30mmHg. Or an increase in the diastolic blood pressure ≥ 15mmHg with protein in urine.
New Preeclampsia Diagnosis Guidelines
According to ACOG, about 10 percent of pregnant women will develop preeclampsia without having protein in urine.
To make this diagnosis in pregnant women
The patient should have developed new onset hypertension with either one or more of the following
- Impaired functions of the kidneys. This is by checking the creatinine level in your blood. Elevated creatinine levels show kidney problems. More damage to the kidneys will result to reduction of urine output. Therefore patients with new onset hypertension with oliguria or raised serum creatinine levels should raise suspicion of preeclampsia.
- Evidence of liver failure. This is by checking your liver enzymes. These enzymes are above normal in liver failure.
- Decreased amount of platelets in the blood. The platelets are less than 100,000/ul. This is thrombocytopenia. Platelets are important in wound healing or injury. It is also an important risk factor for HELLP syndrome.
- Congestion of fluid in your lungs. This will cause difficulty in breathing and cough.
- Visual disturbances
Treatment of Preeclampsia
There is no cure for the preeclampsia. The only cure of preeclampsia is to deliver the baby and placenta. Factors delivered befor delivery include
- The risk the pregnancy posses to the mother and
- The chances of continued survival of the baby.
Treatment of preeclampsia is also dependent on these factors
- The type of preeclampsia. Either mild or severe preeclampsia
- The gestational age (this is the age of your baby).
- The clinical state of the baby. If the baby is in distress or not
- The presence of trained medical personnel and well equipped facility.
Therefore, the main goal of preeclampsia treatment is to reduce mortality to the fetus while also preventing complications in the mother.
Treatment Of Mild Preeclampsia
Pregnant women with mild preeclampsia are asymptomatic. If your doctor diagnoses preeclampsia in your pregnancy, he would request more visits. This is to ensure you are well monitored. Quick intervention is vital in preeclampsia treatment. Furthermore, lifestyle modification is important in preeclampsia. Your doctor may require you to make some changes to your norms. These include
- Bed rest. There is limited evidence to show that bed rest reduces blood pressure. Though it is a routine advise by doctors. However, this can be difficult to achieve in developing countries. Why? because most pregnant women work to make ends meet. Prolonged bed rest also posses a risk of thromboembolism.
- Reduced intake of salt. Large intake of salt will cause high blood pressure. Your doctor would require low salt intake. This is to prevent worsening of the disease.
- Encourage you to drink lots of water
- Stop smoking and alcohol
Delivery plan for mild preeclampsia
The method of delivery is dependent on the maturity of your baby and your health. If both conditions are favorable, your doctor would want to give more time for the baby to mature. If there is danger to your health your doctor quickly delivers your baby through the safest route.
Pregnant women with mild preeclampsia at 37 weeks should be examined. The blood pressure controlled and baby is delivery vaginally.
Pregnant women less than 37 weeks will be given time. This will help to mature your baby with minimal risk to your health. This is conservative treatment of preeclampsia. It is very important because the baby gets more time to mature. Premature babies have huge challenges.
However, delivery by cesarean section is an option. This is especially when there are danger signs to the mother and/or the fetus.
Treatment Of Severe Preeclampsia In Pregnancy
Poorly treated mild preeclampsia can quickly become severe. The cure to preeclampsia in pregnancy is delivery of the baby and placenta.
Below are some of the options taken by your doctor include
• Use of blood pressure lowering drugs. These are medications that lower blood pressure. Severe preeclampsia is treated with blood pressure lowering drugs. This quickly lowers risk of hypertension to your health. However, this will not stop the progression of the disease.
Use of blood pressure lowering drugs are not indicated in mild preeclampsia. Because further reduction of blood pressure will affect blood supply to the baby.
Some of the blood pressure lowering drugs used in pregnancy include
- And many others that are safe for use in pregnancy
While these drugs are safe and can be used in pregnancy, They have side effects. Methyldopa can cause depression, Sedation and nightmares. Hydralazine can cause headache, restlessness and palpitations. Labetalol will cause growth restriction when used for a long time.
However, most of these drugs are safe in pregnancy. Sometime can be combine to have better results.
• Use of magnesium sulphate
Magnisuim sulphate is used in preeclampsia treatment. This is the drug of choice to prevent further complications in pregnancy. Poorly treated preeclampsia can lead to onset of convulsion. This is Eclampsia. The use of magnesium sulphate prevents this onset of convulsion in patients with severe preeclampsia.
Delivery plan for severe preeclampsia
Planning for delivery is an important part of preeclampsia treatment. Your doctor must ensure your safety and that of your baby. Should your pregnancy be 37 -38 weeks, induction of labor in commenced. This is to deliver vaginally except where contraindicated.
However, if pregnancy is terminated before 32 to 34 weeks then you will be given corticosteroids. This is to help the immature lungs of the fetus. Failure to do this would cause neonatal respiratory distress syndrome.
Furthermore, you will agree that vaginal delivery for premature babies will cause more stress. Emergency lower segment cesarean section is important here.
Most patients in labor prevent pain by using analgesia.The most preferred in preeclampsia is epidural analgesia. This helps to control blood pressure and pain. With increase blood supply to the fetus through the placenta.
Having said that, the use of ergometrine in your pregnancy is contraindicated. Ergometrine was previously used to make your uterus contract after delivery. It is still available in many centers where oxytocin is not available. This will cause further rise in blood pressure. Oxytocin is used instead. Oxytocin is used to contract the uterus without raising the blood pressure.
In addition, women still have a role to play in their delivery. Should you decide to deliver vaginally then your doctor will have to assist your delivery with use of forceps. It is however vital to always reduce stress to the baby.
Prevention Of Preclampsia
Most research done in the past have been disappointing. The use of vitamin C, E, D for preventing preeclampsia has shown no benefits. They are no longer used for preventing of preeclampsia.
Most noteworthy, low dose aspirin reduces incidence of preeclampsia. It is commenced in the second trimester of pregnancy. Use of aspirin is stopped towards the end of pregnancy. This will prevent hemorrhage during childbirth. Low dose aspirin is useful in chronic diseases such as hypertension and renal diseases.
Furthermore use of calcium supplementation has shown to be beneficial to pregnant women.
Complications Of Preeclampsia
The effect of preeclampsia on the mother and fetus may affect the outcome of pregnancy. These are a list of possible complications to mother and baby.
- Ecclampsia. This is the onset of convulsion in a pregnant woman with severe preeclampsia. It is one the major cause of death in pregnant women.
- Widespread organ dysfunction.
- Fetal growth restriction with delivery of small babies
- Death of the woman or baby
- Prolonged disabilities in babies such as blindness, cerebral palsy.
- Kidney failure can also occur due to preeclamptic changes in the kidneys
- Liver failure
- Accumulation of fluids in the lungs. This is pulmonary edema
- Abruptio placenta
- Disseminated intravascular coagulation with bleeding
- Increased rate of cesarean section
- Premature babies
Now its your turn. Do you have high blood pressure in pregancy? or have you treated a patient with preeclampsia. lets share your experiences. Comment and share this post on social media.