Pre-eclampsia in pregnancy

Pre-eclampsia-what is it?

Pre-eclampsia, otherwise known as preeclampsia, was once considered “pregnancy poisoning.” The name came from the fact that, in its own way, the body of the mother-to-be is “poisoned” by the developing pregnancy. Pre-eclampsia is the result of abnormal vascular implantation during placenta formation early in pregnancy. This, in turn, in a nutshell, leads to obstructed placental flow in III. trimester, the development of hypertension in the pregnant woman and other complications.

In recent years, scientists have begun to understand the nature of this disease – clinical and laboratory observations have allowed them to assess that it is a heterogeneous (i.e., diverse) affliction, most often associated with vascular factors including excessive production of the soluble form of vascular endothelial growth factor receptor type 1 (sFlt1) and soluble endoglin (sEng).

Pre-eclampsia – types

There are two forms of this disease, which are determined by the stage of pregnancy.

• Late pre-eclampsia, occurring after the 34th week of pregnancy (80% of all cases) – according to observations, arises due to reduced blood flow across the placenta.
• Early pre-eclampsia, manifesting before 34. week of pregnancy (accounts for 5-20% of pregnant women and includes the most severe cases) – specialists say it has a secondary basis, meaning that it develops as a result of diseases that correlate positively with preeclampsia.

Risk of pre-eclampsia – causes

What are the causes of pre-eclampsia? Specialists to this day are unable to find specific reasons, so they have determined risk factors, which we divide into:

High-risk factors:

• Pregnancy hypertension occurring in the current pregnancy,
• chronic kidney disease,
• Autoimmune diseases such as systemic lupus erythematosus or antiphospholipid syndrome,
• Type 1 and Type 2 diabetes,
• chronic hypertension.

Medium-risk factors:

• first pregnancy,
• Age ≥40 years,
• The gap from the previous pregnancy >10 years,
• abnormal body mass index,
• familial occurrence of preeclampsia,
• multifetal pregnancy.

The current data at our disposal describes that the likelihood of pre-eclampsia is also influenced by other conditions, such as, among others. Migraines, multiple infections, painful menstruation or sleep disorders in early pregnancy. Genetic factors, such as the presence of coagulopathy, assisted reproductive techniques and the predisposition of the partner also play an important role.

What are the symptoms of pre-eclampsia?

Symptoms of pre-eclampsia include:

• High blood pressure (which is above 140/90 mm Hg),
• Proteinuria > 0.3 g/24h in daily urine collection;
• severe headaches,
• visual disturbances,
• epigastric pain,
• nausea,
• coagulation disorders,
• Abnormal flows on ultrasound examination.

Pre-eclampsia – diagnosis

Pre-eclampsia is diagnosed based on the symptoms present. Most often, proteinuria and hypertension develop. Liver and kidney dysfunction are emerging. Liver and kidney parameters are also abnormal, in the form of elevated AST or ALT values and creatinine. If preeclampsia is suspected, they require constant monitoring.

It is also very important to monitor fetal well-being, since among the criteria for diagnosing pre-eclampsia are fetal growth restriction and obstructed Doppler flow on ultrasound.

Treatment of pre-eclampsia

The only effective treatment for pre-eclampsia is causal treatment, namely delivery. The decision about it depends on the symptoms present, the clinical condition of the pregnant woman and the well-being of the baby. It is necessary to implement hypotensive treatment, but in a situation of significant severity of symptoms, it is necessary to terminate the pregnancy.

Pre-eclampsia – prevention

It is now possible to prevent pre-eclampsia in pregnancy. At the beginning of pregnancy, specialists, on the basis of a composite test and an ultrasound, calculate, in addition to the risk of chromosomal aberrations, the risk of fetal hypotrophy and pre-eclampsia in certain weeks of pregnancy. If this risk is more than 1:150, the pregnant woman should take acetylsalicylic acid at a dose of 150 mg per night. It is important to implement this prophylaxis before 16. week of pregnancy, that is, before the placenta and vasculature are fully formed. Usually this supplementation lasts until the 36th week of pregnancy. It is recognized that the risk of preeclampsia before 34. Week of pregnancy when taking acetylsalicylic acid drops by 80%.

Another useful test used in determining the risk of preeclampsia is the sFlt-1/PlGF index, which is a determination of placental growth factor and soluble receptor for vascular endothelial growth factor type 1. Their relationship to each other makes it possible to predict the onset of preeclampsia within the next week. This makes it possible to provide specialized care to women at risk of preeclampsia and prevent its serious symptoms.

Does pre-eclampsia affect the baby?

The occurrence of pre-eclampsia during pregnancy is dangerous not only for the woman, but also for her baby. This is because such a phenomenon can accelerate labor, which in turn will result in a premature baby. This has many consequences for the baby – studies show that many premature babies develop cognitive, intellectual and behavioral disorders. Thus, they may exhibit many difficulties in both school and organizational and interpersonal tasks.

In addition, such children are more likely to have mental health problems, which include anxiety or depression. Prematurity is also associated with the malfunction of many organs that have not had time to develop properly. Toddlers born prematurely are much more prone to various types of infections, especially of the respiratory system.

Severe pre-eclampsia – what does it lead to?

The disease is extremely serious and should not be taken lightly. Its effects are mainly felt by the pregnant woman, especially if she does not consult a doctor at the time. This is because pre-eclampsia correlates with an increase in the risk of developing cardiovascular and urinary diseases, and disrupts the function of many organs, most notably the kidneys and liver. It is worth knowing that the affliction can contribute to permanent hypertension and cause a stroke, which is an immediate threat to life.

Failure to deal with pre-eclampsia can turn it into eclampsia, a life-threatening circumstance for mother and child. It manifests with dangerous symptoms, such as, among others. Seizures, loss of consciousness and excessive agitation.

FAQ:

• How is the diagnosis of pre-eclampsia made?

The diagnosis of this condition is symptomatic, which means that it is mainly on the basis of these that the doctor gives the diagnosis. Among them we include. Proteinuria, reduced platelet count, increased blood pressure or visual disturbances.

• Can pre-eclampsia be avoided?

Proper prevention is able to minimize the risk of pre-eclampsia. It is especially recommended for women whose risk is more than 1:150. Then acetylsalicylic acid is administered, and sometimes calcium supplementation is recommended.

• What are the risk factors for pre-eclampsia?

In this affliction, specialists have described two risk factors, namely – high and medium. In addition, other ailments can contribute to the development of pre-eclampsia, such as. Sleep disorders, migraines or recurrent infections.