Preeclampsia affects 2% of pregnancies. It is considered one of the main causes of maternal and perinatal mortality. But is it reversible? Yes! By preventing its effects on the mother and fetus, early risk assessment, and close monitoring of the pregnancy, preeclampsia is reduced to just another potential scenario in a pregnant woman’s adventurous life.
Preeclampsia is a common pregnancy complication, and it is believed that it is usually caused by a problem with the placenta restricting blood flow to the fetus. However, its exact cause is unknown. Only its symptoms -high blood pressure (hypertension) and protein in the urine (proteinuria) for the mother and fetal growth restriction and decreased amniotic fluid)- are known.
What happens to the mother in case of severe PE?
In case of severe preeclampsia, the potential complications are as follows:
- Increased blood pressure (>180 mmHg), which can lead to cerebral hemorrhage
- Liver rupture
- Eclampsia (onset of seizures)
- HELLP syndrome (low platelets and elevated liver enzymes)
The presence of the placenta rather than the fetus is responsible for the development of preeclampsia. That’s why it doesn’t get better until delivery.
How is the fetus affected?
Your baby may be growing too slowly because not enough blood is getting to the placenta. That can lead to the following problems:
- Intrauterine fetal growth restriction (IUGR)
- Reduced amniotic fluid
- Premature birth, and low birth weight
- Neonatal respiratory distress syndrome
- Placental abruption, which can be life-threatening for both the fetus and the pregnant woman
The unborn baby is monitored as closely as the mother, and the delivery is carried out before its problems become serious. Decisions about early induction are particularly difficult.
Who is most at risk for PE?
PE affects about 1 in 10 pregnant women; you’re more at risk if:
- It’ your first pregnancy
- You are aged 40 or more
- It has been 10 years or more since your last baby
- You are expecting twins, triplets, or more
- You already have high blood pressure
- You have previously suffered with PE
- You have diabetes, kidney disease, or migraine
- You have a BMI of 35 or more
Preeclampsia treatment
The goal in preeclampsia treatment is to ensure the health of both the mother and the fetus. And the best strategy is to prevent complications. For that reason, it is important for all women to attend all antenatal check-ups to minimize the risks. Usually, women who comply with their doctor’s instructions and have a mild form of the disease (mild hypertension and an immature fetus, without proteinuria) can stay at home with appropriate medication: antihypertensive drugs, magnesium sulfate (MgSO), and corticosteroids to mature the fetus’s lungs.
It is recommended to remain lying down for most of the day, in a left lateral position. They should consume fluids and limit salt. And to record headaches, visual disturbances, and shortness of breath, take their blood pressure morning-noon-night, monitor their body weight, and measure their urine every 24 hours with a urine albumin stick.
In more severe cases, pregnant women are admitted to the hospital, where the mother’s functions are monitored around the clock and she receives antihypertensive treatment to prevent eclampsia. In the event of eclampsia, the priority is to maintain the mother’s vital signs and control seizures, prevent seizure recurrence, and assess the conditions for delivery.
Preeclampsia screening
As a maternal-fetal medicine (MFM) specialist, I provide care for women with complicated pregnancies, such as high-risk pregnancies, preeclampsia, etc. Preeclampsia screening can be achieved in the first trimester of pregnancy by an early 11-13 week nuchal scan and continued with various Doppler scans (to check blood flow through the placenta, measure the growth of the baby, and determine how much amniotic fluid there is) and various blood tests (to check the patient’s kidney and liver health). Monitoring twice a week of the baby’s heart rate using a process called cardiotocographic monitoring (NST), which can detect any stress or distress in the unborn child, is recommended.
Finally, a biophysical profile (a combination of NST findings with ultrasound parameters: movements, muscle tone, breathing, and assessment of amniotic fluid volume) can assure us that both mother and baby are happy and healthy.
For more information you could visit the following websites:
https://action-on-pre-eclampsia.org.uk/support/pre-eclampsia-information/
Προεκλαμψία Αντιμετώπιση
Ο στόχος στη θεραπεία της προεκλαμψίας είναι η υγεία της μητέρας και του εμβρύου. Η κυριότερη στρατηγική είναι η πρόληψη των επιπλοκών στη μητέρα και το έμβρυο. Κύριος στόχος είναι ο έλεγχος της αρτηριακής πίεσης (η συστολική -160 και η διαστολική -100). Συνήθως οι γυναίκες που συμμορφώνονται με τις οδηγίες του γιατρού και έχουν ήπια μορφή της νόσου (ήπια υπέρταση και ανώριμο έμβρυο, χωρίς πρωτεϊνουρία, μπορούν να παραμείνουν στο σπίτι με αγωγή. Συνιστάται να παραμείνουν ξαπλωμένες τις περισσότερες ώρες της ημέρας, κυρίως σε αριστερή πλάγια θέση. Να καταγράφουν πονοκεφάλους, διαταραχές οράσεως, δύσπνοιες και να μετρούν πίεση πρωί-μεσημέρι, βράδυ, να παρακολουθούν το σωματικό τους βάρος (να μην αυξηθεί υπέρμετρα) και να μετρούν ανά 24ωρο τα ούρα με stick πρωτεϊνουρίας. Για το έμβρυο, 2 φορές την εβδομάδα πρέπει να γίνεται καρδιοτοκογραφικός έλεγχος και εξέταση Doppler.
Σε βαρύτερες περιπτώσεις οι έγκυοι εισάγονται στο νοσοκομείο όπου ελέγχονται οι λειτουργίες της μητέρας σε 24ωρη βάση και δέχεται αντιϋπερτασική θεραπεία για την πρόληψη της εκλαμψίας. Σε περίπτωση εκλαμψίας, προέχει η διατήρηση των ζωτικών σημείων της μητέρας και ο έλεγχος των σπασμών, η πρόληψη της υποτροπής των σπασμών και η εκτίμηση των προϋποθέσεων τοκετού. Ιδίως όταν υπάρχει υποψία επικείμενης εκλαμψίας, πολυοργανική δυσλειτουργία ή εμβρυική δυσφορία ή όταν η βαριά προεκλαμψία λαμβάνει χώρα μετά τις 34 εβδομάδες. Παρ’ όλα αυτά, σε πρωιμότερα στάδια εγκυμοσύνης, η παράταση της εγκυμοσύνης υπό στενή παρακολούθηση με σκοπό τη βελτίωση της νεογνικής βιωσιμότητας ενδείκνυται.
