What is PreEclampsia?
Definition:
PreEclampsia is a syndrome unique to the pregnancy state. It occurs typically in the latter stages of pregnancy but has been found earlier than 26 weeks. The syndrome requires elevation of blood pressure and either edema (swelling, typically of the face or hands) and/or protein spillage into the urine. The typical prenatal visit always includes screening for preEclampsia by checking a patient's weight, blood pressure, urinalysis and physical symptoms. It is the constellation of symptoms and signs that occur prior to the onset of seizures or Eclampsia and hence the name Pre-Eclampsia.
Risk Factors for Developing it:
Preeclampsia is most often seen in first-time pregnancies and in pregnant teens and women over 40. Other risk factors include:
- Pre-pregnancy blood pressure elevation
- Previous history of preeclampsia
- A family history of preeclampsia in mother or sisters. Pre pregancy obesity
- Multiple gestation (twins)
- History of diabetes, kidney disease, lupus, or rheumatoid arthritis
Physiology:
Women destined to develop preEclampsia tend to have lost the ability for their blood vessels to relax during pregnancy as the body attempts to accomodate a large increase in intravascular volume. In these patients, the unrelaxed (tense) blood vessels translates to higher blood pressure and as blood vessels are found in every part of the body, pre Eclampsia can affect multiple organ systems. Nobody has ever discovered exactly what it is that causes this in some women and not in others.
Degrees of Severity:
We tend to think of preEclampsia as either 'Mild' or 'Severe' and there are several variant forms such as HELLP syndrome and superimposed preEclampsia which seem to be particularly more agressive forms. Mild preEclampsia is typically a diagnosis given to a patient when the criteria for preEclampsia are met but she has no other symptoms or abnormal organ system tests. The patients reflexes may be significantly elevated. Severe PreEclampsia is a diagnosis given to that patient as above but in addition has symptoms of :
- severe headaches unresponsive to medicines
- disturbance (blurred vision or bright spots)
- Nausea and Vomiting
- Severe mid abdominal/mid epigastric pains
- Severe amounts of protein spillage into the urine
- abnormal liver enzymes
- low platelet count
- A baby that is <10th%ile in body wt.
- Renal failure or evidence towards such
- lung or brain swelling (edema)
Treatment
PreEclampsia is only cured by delivery of the baby but the timing and route of delivery will vary from patient to patient and their particular degree of severity and their doctor's assessmant of risk to the Mother vs risk to delivery of the baby which may be preterm. Typically, during delivery magnesium sulfate is useful to help prevent worseing of preEclampsia to seizure onset (eclampsia) and blood pressure is typically treated with a variety of antihypertensive agents.
Future Implications of preEclampsia complicating Pregnancy
Having a history of preEclampsia is a risk factor for recurrance of the syndrome. But most patients will recover speedily and completely from their experience and not have it recur in the future. Your doctor will check you during your next pregnancy quite frequently for evidence of chronic hypertension or recurrant pre eclampsia.