Preeclampsia What we need to know

15.12.2023

Preeclampsia is a condition developed at 20 weeks or more of pregnancy, which poses a threat to both the mother and the fetus. The reasons for its development have not been fully clarified, however, according to available data, it is more common during the first pregnancy. There are certain factors that contribute to the development of preeclampsia, such as:

Table of Contents

History of arterial hypertension, diabetes and kidney damage

Multiple pregnancy

Family history of preeclampsia

Autoimmune diseases such as systemic lupus erythematosus and others

Obesity

Disruption of blood circulation in the placenta is considered the main cause of preeclampsia development. The pathogenesis of the disease is multifactorial. The main reason is the pathological transformation of the blood vessels of the placenta, which leads to a decrease in blood supply to the placenta and fetus and dysfunction of the placenta.

Dysfunction of the placenta leads to an imbalance of circulating angiogenic factors (factors that ensure the development of placental blood vessels and adequate blood supply), which ultimately leads to the development of preeclampsia-eclampsia.

preeclampsia Risk-factors

Preeclampsia in previous pregnancy
Multiple pregnancy
Concomitant diseases: hypertension, chronic kidney disease, type I diabetes, antiphospholipid syndrome, systemic lupus erythematosus.
Family history of preeclampsia (mother, sister)
Obesity
Age above 40 years
thrombophilia
In-vitro fertilization

Does stress cause preeclampsia?

Although stress can increase blood pressure, stress is not a direct cause of preeclampsia.

As a rule, pre-eclampsia starts at 20 weeks, although it can start earlier. Rarely, preeclampsia occurs within a few days after delivery.

Symptoms

During preeclampsia, arterial hypertension develops from the 20th week of pregnancy and at least one of the following symptoms:

Proteinuria – the presence of proteins in the urine
Other signs of renal dysfunction
A decrease in the number of platelets in the blood
Elevation of liver enzymes in the blood, which indicates liver cell damage
Pulmonary edema
Headache, with ineffective medical treatment
Right sided abdominal pain
Shortness of breath
Disruption of vision

Preeclampsia may begin asymptomatically, but most pregnant women have hypertension, proteinuria (protein in the urine) and edema as the first symptoms. Sometimes a pregnant woman does not even know that she has preeclampsia, so it is important to provide all the symptoms in detail to the supervising gynecologist.

High blood pressure

Blood pressure includes two indicators: systolic and diastolic. Systolic pressure is created by the contraction of the left ventricle of the heart and the flow of blood through the blood vessel. Diastolic pressure is the indicator that is created on the wall of the blood vessel during the relaxation of the left ventricle of the heart (during diastole).

Arterial hypertension during pregnancy is diagnosed when blood pressure readings exceed 140/90 mmHg. To determine the causes of pressure increase, it is necessary to conduct additional laboratory studies to detect preeclampsia.

Blood analysis: Liver and kidney function tests, determination of platelets are necessary.

Urine analysis: Along with the general analysis of urine, it is important to determine the protein in urine and its breakdown products.

Fetal ultrasound: By estimating the weight of the fetus and the amount of amniotic fluid

Diagnosis

The diagnostics of preeclampsia is usually made by scheduled routine pregnancy tests - blood pressure data, blood and urine tests. If preeclampsia is expected (based on clinical and anamnestic data), additional tests may be prescribed:

Kidney and liver function tests
Determination of protein in 24-hour urine
Ultrasound evaluation of the fetus
Determination of preeclampsia factors (sFlt-1/PlGF)

Treatment

The primary treatment approach is to either induce labor artificially or manage the situation to select a better time for delivery.

If the episodes of preeclampsia are not very severe, the situation can be managed with regular visits to the doctor and follow-up tests.

Severe preeclampsia requires inpatient management.

giving birth

If the condition of the pregnant woman and the clinical and laboratory data allow, it is possible to delay the delivery up to 37 weeks. In severe preeclampsia, immediate intervention is often recommended. When choosing the method of delivery, the decision is based on the condition of the mother and the fetus, the severity of the disease and many other factors.

Prevention

For people who are at risk of developing preeclampsia, there are some simple steps you can take to prevent the development of the disease:

Blood pressure and blood glucose control
Weight regulation
Maintaining regular physical activity during pregnancy
Sleep regulation
A healthy diet free of excess fat and salt

forecast

Untreated preeclampsia has a poor prognosis for both mother and fetus. The most common complications are premature birth with an immature fetus and placental abruption.

Preeclampsia causes HELLP syndrome: hemolysis, elevation of liver enzymes in the blood, decrease in the number of platelets. The syndrome is also characterized by blurred vision, chest pain, headaches and nosebleeds.

The danger of the following complications develops in the postpartum period:

Kidney disease
heart attack
stroke
In pregnancies following episodes of preeclampsia

When to see a doctor?

In a condition similar to fainting or fainting during pregnancy
in case of respiratory failure
During acute abdominal pain
When vision deteriorates
In severe headache
during pronounced hypertension

What is the difference between preeclampsia and eclampsia?

Eclampsia is severe preeclampsia that causes heart palpitations. It is considered a complication of preeclampsia, although it may occur without symptoms of preeclampsia. In rare cases, eclampsia is followed by coma, stroke and even death.

What is postpartum preeclampsia?

Postpartum preeclampsia develops within 2 days after delivery, rarely - in a few weeks. The symptoms are exactly the same as in preeclampsia of pregnancy.

Will preeclampsia pass after childbirth?

Within a few days or weeks after delivery, the symptoms of preeclampsia will disappear. Symptomatic treatment is required. People who experienced preeclampsia at an earlier stage of pregnancy (up to 20 weeks) have a higher risk of developing arterial hypertension and cardiovascular pathologies after pregnancy.