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Pre-eclamsia

Pre-eclamsia

Contents of this article:

  1. About pre-eclampsia and its symptoms
  2. Causes
  3. Risk factors
  4. Pre-eclampsia and your baby
  5. Pre-eclamsia and high Bp
  6. Diagnosis
  7. Treatment
  8. Complications
  9. Prevention

What is pre-eclampsia?

Pre-eclampsia is a common condition that only occurs during pregnancy, Affecting the mother, baby or both. It can develop from around 20 weeks of pregnancy to as late as several days after delivery, the severity of which can vary. In the mother, the condition causes high blood pressure and protein leaks from the kidneys into the urine, other symptoms may develop and are mentioned below. For the baby, growth may be slower than normal.

What are the symptoms?

The severity of pre-eclampsia is usually (but not always) linked to the blood pressure level. You may not have any symptoms at first; if pre-eclampsia worsens one or more of the following symptoms may develop:

  • Severe headache that doesn’t go away with simple painkillers
  • Problems with vision, such as blurring or flashing before the eyes
  • Severe pain just below the ribs
  • Heartburn that doesn’t go away with antacids
  • Rapidly increasing swelling of the face, hands or feet
  • feeling very unwell.

These symptoms are serious and you should seek medical help immediately. In severe pre-eclampsia, other organs, such as the liver or kidneys, can sometimes become affected and there can be problems with blood clotting. Severe pre-eclampsia may progress to convulsions or seizures before or just after the baby’s birth. These seizures are called eclamptic fits and are rare, occurring in only one in 4000 pregnancies.

What causes pre-eclampsia?

Experts are not sure why preeclampsia occurs. Most say that there is a problem with the development of the placenta because the blood vessels that supply it are narrower than normal and respond differently to hormonal signals.

Because the blood vessels are narrower than normal, blood flow is limited.

Why the blood vessels develop differently is not fully understood, but a number of factors may play a role; including:

  • damage to the blood vessels
  • insufficient blood flow to the uterus
  • immune system problems
  • genetic factors

Who are at risk of pre-eclampsia?

Risk factors associated with preeclampsia include:

  • First pregnancies. The chances of preeclampsia during a first pregnancy are considerably higher than the subsequent ones.
  • Pregnancy gap. If the second pregnancy occurs at least 10 years after the first, the second pregnancy has an increased risk of preeclampsia.
  • New paternity. Each pregnancy with a new partner raises the risk of preeclampsia when compared with a second or third pregnancy with the same partner.
  • Family history. A woman whose mother or sister had preeclampsia has a higher risk of developing it herself.
  • Personal history of preeclampsia. A woman who had preeclampsia in her first pregnancy has a much greater risk of having the same condition in her subsequent pregnancies.
  • Age. Women over 40 and teenagers are more likely to develop preeclampsia compared with women of other ages.
  • Certain conditions and illnesses. Women with diabetes, high blood pressure, migraines, and kidney disease are more likely to develop preeclampsia.
  • Obesity. Preeclampsia rates are much higher among obese women.
  • Multiple pregnancies. If a woman is expecting two or more babies, the risk is higher.

How may pre-eclampsia affect my baby?

Pre-eclampsia affects the development of the placenta (afterbirth), which may prevent your baby growing as it should. There may also be less fluid around your baby in the womb. If the placenta is severely affected, your baby may become very unwell. In some cases, the baby may even die in the womb. Monitoring aims to pick up those babies who are most at risk.

Is pre-eclampsia the same as high blood pressure of pregnancy?

No. many women develop high blood pressure. Most do not have pre-eclampsia.With pre-eclampsia you have high blood pressure, plus protein in your urine, and sometimes other symptoms listed below. About 1 in 5 women with high blood pressure progress to pre-eclampsia.

Therefore, if you develop high blood pressure you will have regular ante-natal checks which can detect pre-eclampsia, if it occurs, as early as possible.

How is pre-eclampsia detected?

Pre-eclampsia can develop anytime after 20 weeks of pregnancy.

Most commonly pre-eclampsia is present if:

  • Your blood pressure is high and
  • You have an abnormal amount of protein in your urine

Serial blood pressure monitoring, detailed urine tests and blood tests will help with the diagnosis of pre-eclampsia.

What is the treatment for pre-eclampsia?

The only complete cure for pre-eclampsia is to deliver the baby. At delivery the placenta is also delivered, therefore, the cause of the condition is removed. After the birth, the blood pressure and any other symptoms in the mother usually settle quickly.

It is common practice to induce labour if pre-eclampsia occurs late in pregnancy.

The risk to the baby is small if he or she is born a few weeks early. The best time to deliver the baby has to balance several factors including:

  • The severity of the condition in the mother, and the risk of complications occurring.
  • How the baby is affected.
  • The chance of a premature baby doing well. Generally, the later in

pregnancy the baby is born, the better. However some babies grow very

poorly if the placenta does not work well in severe pre-eclampsia. They

may do much better if they are born, even if they are premature.

If pre-eclampsia is severe, then delivery sooner rather than later is best. If the pre-eclampsia is not too severe, then postponing delivery until nearer full termmay be best.

 

Other treatments

Until the baby is delivered, other treatments that may be considered include:

  • Medication to reduce blood pressure: Medication to reduce blood

pressure may be an option for a while if pre-eclampsia is not too severe.

If the blood pressure is reduced it may help to allow the pregnancy to

progress further before delivering the baby.

  • Rest: Rest is often recommended although there is little evidence that

this makes much difference.

It is sometimes necessary to admit women with pre-eclampsia to hospital, particularly if it is severe. This is not just for rest, but also to monitor the mother and developing baby.

Preeclampsia and complications

If preeclampsia is not treated, there is a risk of serious complications. Complications are rare if the woman goes to antenatal appointments. However, if the condition is not diagnosed for some reason, the risks are considerably greater.

The following complications may develop from preeclampsia:

HELLP syndrome: HELLP can become life-threatening very quickly, for both the mother and the baby. It stands for hemolysis, elevated liver enzymes, and low platelet count. It is a combined liver and blood clotting disorder that most commonly occurs right after giving birth, but can appear at any time after the 20th week of pregnancy. Very rarely, it may occur beforehand. The only way to treat HELLP syndrome effectively is to deliver the baby as soon as possible.

Poor blood flow to the placenta: If blood flow to the placenta is restricted, the baby might not be getting oxygen and nutrients, which may lead to slower growth, breathing difficulties, and premature birth.

Placental abruption: The placenta separates from the inner wall of the uterus. In severe cases, there may be heavy bleeding, which can damage the placenta. Any damage to the placenta may place the baby’s and mother’s life at risk.

Eclampsia: Basically a combination of preeclampsia and seizures. The woman may experience pain under the ribs on the right side of her body, intense headache, blurry vision, confusion, and decreased alertness. If left untreated the woman is at risk of going into a coma, suffering permanent brain damage, and dying. The condition is life-threatening for the baby as well.

Cardiovascular disease: Women who have preeclampsia have a higher risk of developing cardiovascular diseases later in life.

Preeclampsia can have some long-term consequences for the developing baby. Research has shown that high blood pressure in pregnant women may affect the baby’s cognitive skills, which can carry through into later life.

Can pre-eclampsia be prevented?

There is some evidence to suggest that regular low dose aspirin and calcium supplements may help to prevent pre-eclampsia in some women. These are not standard or routine treatments as the evidence for their benefit is not strong or conclusive. However, one or other may be considered by a specialist if you have a particularly high risk of developing pre-eclampsia.

Will pre-eclampsia develop in my next pregnancy?

If you had pre-eclampsia in your first pregnancy, you have about a 1 in 10 chance of it recurring in future pregnancies. There is no way of predicting if it will happen again.

If you do not have pre-eclampsia in your first pregnancy, it is unusual to

develop it in future if you become pregnant again by the same partner.

About Author

Hanan Ahmed Mohamed is registered midwife graduated from Edna Adan University Hospital year 2015. She currently works at Somaliland Family Health Association (SOFHA) a national NGO that focuses on proving antenatal care, post natal care, training, health-care promotion, vaccination, counseling and family planning. 

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