Preeclampsia During Pregnancy


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Evidence Based - Facts Checked

Do you know that hypertension (high blood pressure) is the most common medical disorder during pregnancy?1Sibai, Baha & Stella, Caroline. (2010). 'Diagnosis and Management of Atypical Preeclampsia-Eclampsia' Source

Preeclampsia is hypertension ( Blood Pressure more than or equal to 140/90 mm Hg on two occasions measured at least 4 hours apart but not > 7 days apart2Sibai, Baha & Stella, Caroline. (2010). 'Diagnosis and Management of Atypical Preeclampsia-Eclampsia' Source) that develops after 20 weeks of pregnancy. During preeclampsia, protein in the urine increases. Further, organ damage may happen3Peres, G. M., Mariana, M., & Cairrão, E. (2018, January 17). 'Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal.Source and the kidney is mainly affected during Preeclampsia4Al-Jameil, N., Aziz Khan, F., Fareed Khan, M., & Tabassum, H. (2014, February). A brief overview of preeclampsia. Source.

You will be surprised to learn that 60,000 mothers die all over the world every year due to preeclampsia5Duhig, K., Vandermolen, B., & Shennan, A. (2018, February 28). 'Recent advances in the diagnosis and management of pre-eclampsia' Source.

If not treated, it can lead to a more severe form ( eclampsia ), wherein the pregnant mothers may experience seizures along with the existing symptoms of preeclampsia6Peres, G. M., Mariana, M., & Cairrão, E. (2018, January 17). 'Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal.Source.


What is the Cause of Preeclampsia

The exact cause7Al-Jameil, N., Aziz Khan, F., Fareed Khan, M., & Tabassum, H. (2014, February). 'A brief overview of preeclampsia.Source is still unknown, but it is believed that it happens due to an abnormal placentation. (placenta is an organ which provides nutrition to a growing baby in the womb)

This abnormal placenta releases certain factors (protein, the debris of placenta etc.) into the mother’s blood, which damages the blood vessels. This causes endothelial cell dysfunction, (a disorder in which blood vessels get constricted ), thereby leading to an increase in the blood pressure8Pankiewicz, K., Szczerba, E., Maciejewski, T., & Fijałkowska, A. (2019, June). 'Non-obstetric complications in preeclampsia' Source. Damage to the blood vessels affects organs of the body as the blood carrying capacity decreases. A part of the kidney, glomerulus, swells, and the kidney’s sieving mechanism gets affected. This is why there is an increase in the presence of protein in the urine during preeclampsia.

Quick Note - Why does the constriction of blood vessels lead to an increase in blood pressure?

To understand this, imagine a pipe with a large diameter through which water is flowing. Now, if you make the diameter of the pipe small, the pressure is going to increase. This is how blood vessels work when they get constricted.

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Are you at Risk of Suffering from Preeclampsia During Pregnancy?

If you are pregnant or are planning to get pregnant, consider the following risk factors that can make a woman prone to preeclampsia9Duhig, K., Vandermolen, B., & Shennan, A. (2018, February 28). 'Recent advances in the diagnosis and management of pre-eclampsia' Source:-

High-Risk Factors

- Chronic kidney disease

- Chronic hypertension

- Diabetes ( type 1 and 2)

- Autoimmune disease ( diseases in which the immune system attacks its cells)

Moderate Risk Factors

- First pregnancy

- Pregnancy at or more than 40 years of age

- The time gap between the previous and current pregnancy is more than ten years

- Body mass index ( BMI ) - 35 kg/meter square or more

- Family history of preeclampsia or hypertension

- Multiple Pregnancies

- Deficiency of vitamin D is also suggested to be a risk factor for preeclampsia


What happens if you have Preeclampsia?

As discussed earlier, high blood pressure and protein in urine are two significant symptoms of preeclampsia during pregnancy. There might be other symptoms suggestive of preeclampsia during pregnancy, which are as follows10Peres, G. M., Mariana, M., & Cairrão, E. (2018, January 17). 'Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal.Source:-

Preeclampsia Symptoms

1. Headache – especially if onset is after 16 weeks of pregnancy, preeclampsia should be strongly suspected and evaluation should be done accordingly.

2. Visual disturbances - The visual disturbances can be in the form of double vision ( when you see two images of a single thing), blurred vision or even blindness (due to retinopathy).

3. Oliguria - Oliguria is defined as low urine output. Oliguria is a sign of acute kidney damage in preeclampsia.

4. Abdominal Pain - Severe upper abdominal pain just below the sternum or right hypochondrial pain can also occur in preeclampsia.

5. Edema - Swelling of feet or legs due to edema is one of the earliest signs of preeclampsia, especially if it is also present when you wake up in the morning ( different from physiological edema of pregnancy, which happens after prolonged activity). An easy way for you to assess if you have swelling is to see if there has been a recent tightening of finger rings or foot slippers.

Edema during preeclampsia happens due to the loss of protein from the body.

6. Abnormal Kidney Tests - In preeclampsia during pregnancy, the glomerular filtration rate decreases. As a result, there is a reduction in urine output, and protein’s presence in urine is noticed. Further, due to decreased urine output, sodium and water retention occur, leading to swelling of hands and feet.

7. Chest Pain and Difficulty in Breathing - occur in severe preeclampsia due to pulmonary (lung) edema. In this condition, water gets accumulated in the lungs due to heart failure and thus causes difficulty in oxygen absorption.

8. Decreased Oxygen Levels in the Blood - The average oxygen saturation level in the mother’s blood should be at least 97%. but in the case of preeclampsia, the oxygen saturation level drops. In preeclampsia, during pregnancy, if the oxygen level drops to less than or equal to 93%, it may add risk to the pregnancy. The pregnant lady shall experience shortness of breath and chest pain when the oxygen level decreases.

9. Abnormal Liver Tests - Elevated levels of liver enzymes are noticed during preeclampsia in pregnancy. Persistent epigastric pain ( pain in the stomach below the ribs ) or right quadrant stomach pain may happen during abnormal liver functioning11Dacaj, R., Izetbegovic, S., Stojkanovic, G., & Dreshaj, S. (2016, February). 'Elevated Liver Enzymes in Cases of Preeclampsia and Intrauterine Growth Restriction' Source.

10. Nausea

11. Rapid weight gain

Do you know preeclampsia can develop without the usual symptoms?

Preeclampsia and even eclampsia may develop in the absence of either hypertension or proteinuria. Such a type of preeclampsia is termed atypical preeclampsia. The patient may experience delayed clotting of blood / bleeding, swelling in the face, hands, and feet, pain in the stomach (epigastric pain), nausea, vomiting, or elevated liver enzymes and decrease in platelet count12DSibai, Baha & Stella, Caroline. (2010). 'Diagnosis and Management of Atypical Preeclampsia-Eclampsia' Source


How to Reduce the Risk of Preeclampsia?

Low dose of aspirin

Doctors may prescribe aspirin (a blood thinner) right from the first week of pregnancy. The patient shall get the maximum benefit when aspirin is started before the pathological process starts ( before 16th week of pregnancy)13Peres, G. M., Mariana, M., & Cairrão, E. (2018, January 17). 'Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal.Source.

Calcium Supplements

In low and middle-income countries, where women do not consume a calcium-rich diet, calcium supplementation can decrease preeclampsia risk by half14CM;, B. E. (2014). 'Treatment of preeclampsia: Current approach and future perspectivesSource.

Weight

Weight is a risk factor for preeclampsia during pregnancy. Some studies suggest that weight loss reduces the risk of preeclampsia15CM;, B. E. (2014). 'Treatment of preeclampsia: Current approach and future perspectivesSource.


How is Preeclampsia Diagnosed?

Following are the various steps of diagnosing Preeclampsia16Wagner, L. K. (2004, December 15). 'Diagnosis and Management of Preeclampsia' Source:-

1. History of patient

Your gynecologist may start by documenting your medical history, which shall be analyzed to predict preeclampsia’s risk factors in your case.

2. Physical examination

After assessing the medical history, your gynecologist may check blood pressure over a period of time to evaluate its pattern. Also, any visible symptoms of edema of the face and rapid weight gain are looked for during the physical examination.

Although these two factors are not exclusively found in preeclampsia during pregnancy; however, gynecologists take these factors for a better picture.

3. Laboratory examinations

There is no reliable screening test for preeclampsia yet. In females with a high risk of preeclampsia, lab investigations are performed during the early pregnancy stage, which includes:-

- Liver Function Test

- Platelets count test

- Kidney Function Test

- 12-24 hour urine test ( to check the percentage of protein in urine)

- A baseline sonogram may be done between 25 to 28 weeks of gestation in cases of a high risk of preeclampsia to evaluate fetus growth in the womb

- Color doppler is done to assess the blood flow to the baby. In case of any retardation in growth, absence or reversal of diastolic blood flow to the baby or in the case of brain sparing effect ( blood flow to the baby is reduced and as a result of which the entire blood is directed to baby's brain to preserve nutrient and oxygen supply) premature delivery may be planned by your gynecologist.


Once Preeclampsia is Diagnosed

1. Once a diagnosis is made, the blood tests should be repeated weekly to check the progress of the disease)

2. Antepartum testing with a nonstress test ( a simple, non-invasive way to check baby’s health) should be done

 3. A detailed ultrasound should be done to track the growth of the fetus


What are the Various Complications that Can Arise in Preeclampsia During Pregnancy?

Following are the various complications that can arise in preeclampsia during pregnancy17Pankiewicz, K., Szczerba, E., Maciejewski, T., & Fijałkowska, A. (2019, June). 'Non-obstetric complications in preeclampsia' Source:-

- Preterm delivery ( birth of the child before 37th week of pregnancy)

- Fetal growth retardation

- Intrauterine fetal death

- HELLP syndrome

 Following are the medical conditions that may occur during HELLP Syndrome apart from the risk of liver rupture:-

    a) Hemolysis (which means rupturing of red blood cells)

    b) Elevated liver enzymes

    c) Low platelet count

Eclampsia ( Preeclampsia associated with seizures)

As an extension to the symptoms of Preeclampsia during pregnancy, the patient may have multiorgan disorders like kidney failure, liver failure, stroke, heart diseases, blood coagulation disorders etc. If not treated, it can result in coma as well as the death of the patient.

- Pulmonary edema and Right Heart Failure 

- Abruptio Placenta 

Abruptio Placenta is a condition in which the placenta may separate from the uterine wall causing severe pain, excessive bleeding and may rapidly cause fetal death. It is an emergency situation that requires immediate Cesarean section to save the mother and the baby ( if fetal death has not yet occurred)

- Disseminated Intravascular Coagulation (DIC)

Disseminated Intravascular Coagulation is a condition in which the blood coagulation profile is deranged due to the consumption of blood clotting factors. It may be associated with abruptio placentae due to severe bleeding. In such a condition, the body is unable to control bleeding, and it may be a life-threatening situation for the mother.

When to see a doctor?

During your routine visits to the gynecologist, a checkup for preeclampsia symptoms shall be done; however, if you notice unexplained swelling in your body, notice a change in urine output or start feeling headache and nausea, it is suggested to make a visit to your gynecologist. Further, if you notice a difference in the fetal movement or no movement at all, it is advised to rush to the hospital for an immediate checkup. If sudden bleeding occurs along with severe pain abdomen and loss of fetal movements, immediate medical attention with your gynecologist should be sought.



Frequently Asked Questions

1. Does child’s growth get affected if the mother has preeclampsia?

A child born from women who had preeclampsia during her pregnancy is also at greater risk for cardiovascular events, elevated BP, BMI during his lifetime18Peres, G. M., Mariana, M., & Cairrão, E. (2018, January 17). 'Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal.Source.

2. Can preeclampsia develop at <20 weeks of pregnancy?

Yes, preeclampsia can develop before 20 weeks of pregnancy. In such a case, where the patient does not have a reason for hypertension and proteinuria other than preeclampsia, the subject is regarded as a severe preeclampsia case. Moreover, if you develop seizures, hypertension, and proteinuria during the first trimester, your gynecologist will treat it as a case of eclampsia until proven otherwise19Schena, F. P., Thomas, W., Griffiths, M., Nelson-Piercy, C., & Sinnamon, K. (2012, December). 'Pre-eclampsia before 20-week gestation: Diagnosis, investigation and managementSource.

3. Can bed rest in pregnancy prevent preeclampsia?

Generally, bed rest or rest at home is not recommended (unless recommended by your gynecologist) in preeclampsia during pregnancy20CM;, B. E. (2014). 'Treatment of preeclampsia: Current approach and future perspectives'. Source.due to the risk of deep vein thrombosis. It is a medical condition in which blood clots are formed in your veins, especially in your legs, which can lead to pain and swelling of legs.

If these blood clots extend to the lungs, it may obstruct the blood vessels. This condition is called as pulmonary embolism, in which the patient shall experience shortness of breath and chest pain.

4. How long does the body take to normalize blood pressure after delivery if the patient already was suffering from Preeclampsia during pregnancy?

Generally, few hours but may remain high for 2 to 4 weeks. If high blood pressure sustains for more than 12 weeks post-delivery, then your physician shall treat it as chronic hypertension2121Wagner, L. K. (2004, December 15). Diagnosis and Management of Preeclampsia. Source


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This content is medically reviewed by Dr. Akanksha Bansal and written by Dr. Vijaya Dutta

Last Medical Review Date - 10th November 2020



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This content is only for educational purpose and should not be considered as a substitute for your Physician's/Doctor's clinical judgement

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