Preeclampsia

What is Preeclampsia?
Preeclampsia is a disease of pregnancy that affects the lining of the mother's blood vessels causing high blood pressure, leaking of fluid from the blood vessels, and damage to multiple organs. Preeclampsia is believed to be caused by an abnormal placenta releasing higher than normal amounts of substances that control the growth of blood vessels and the placenta.  Preeclampsia tends to be milder when it occurs late in pregnancy, but can progress very quickly at anytime to a severe form with the development of very high blood pressure and seizures (eclampsia). Severe preeclampsia can also cause fetal growth restriction (poor growth of the baby) , placental abruption (the placenta separates from the wall of the uterus), stroke, pulmonary edema (fluid in the lungs) , bleeding disorders, kidney failure, and liver swelling.

Who gets Preeclampsia?
About 5% to 7% of all pregnancies are affected by preeclampsia Women are more likely to develop preeclampsia during their first pregnancy, if they are over the age of 40,  have diabetes, a multiple gestation (twins), a family history of preeclampsia, had preeclampsia in a previous pregnancy, or  they have had  in vitro fertilization.  Women with antiphospholipid syndrome, chronic hypertension, and chronic renal disease are ten times more likely to develop preeclampsia than women without these conditions. Most women with early preeclampsia do not have symptoms. When symptoms occur they usually occur in the second half of pregnancy and may include:

  • Persistent headache not relieved by pain medication
  • Visual disturbance such as double vision, sensitivity to light, blurred vision, dimmed vision., loss of vision, or flashing lights (fireworks)
  • Pain in right upper or middle upper abdomen
  • Nausea or vomiting
  • Difficulty breathing, new onset shortness of breath, cough, or rapid breathing
  • Dark colored urine, blood in urine, or decreased amount of urine
  • Decreased fetal movement
  • Sudden weight gain

  • Call your doctor if you notice any of the above symptoms

    How is Preeclampsia Diagnosed?
    The American College of Obstetricians and Gynecologists (ACOG) recommends that preeclampsia should be  diagnosed if the following conditions are met:
    High blood pressure occurs for the first time after 20 weeks  AND
    Protein is in the urine OR 
    ANY  OF THE  FOLLOWING SEVERE FEATURES
     Cerebral or visual disturbances (as above noted under symptoms), pulmonary edema (fluid in the lungs), low number of platelets (cells that help blood to clot), increased liver enzymes (transaminase) , new or worsening kidney failure.
    Women who develop high blood pressure for the first time after 20 weeks, but do not have protein in their urine or severe features of preeclampsia are diagnosed with
    gestational hypertension (GHTN).

    How is Preeclampsia Treated?

  • Blood pressure medications are given to reduce the chance of strokes, heart failure, and kidney injury in women with  SBP greater than or equal to 160 mm Hg or DBP  greater than or equal to 110 mm Hg .
  • Magnesium sulfate is given to treat eclampsia (new onset grand mal  seizures), or  to prevent eclampsia  during labor ,during cesarean section, and after delivery in women with SBP greater than or equal to 160 mm Hg ,  DBP  greater than or equal to 110 mm Hg , OR  with severe features of preeclampsia, or hyperactive reflexes
  • Medication (corticosteroid) to help the fetal lungs mature and reduce other complications of being born prematurely are  given to women  with a viable fetus who must be delivered before 34 weeks' .
  • Delivery is the only cure for preeclampsia. However, the timing of delivery will depend on the severity of the disease and age of the fetus. The mode of delivery (vaginal or cesarean) is determined by the age of the fetus, presentation, cervical status, and maternal or  fetal conditions.
    ACOG recommends
  • Preeclampsia with severe features at 34 weeks or after should be delivered when the mother's condition is stable.
  • Gestational hypertension (GHTN) or preeclampsia without severe features at  37 weeks or after should be delivered
  • Preeclampsia with severe features after viability and before 34 weeks should be hospitalized at a facility with maternal and neonatal intensive care resources.
  • Women with GHTN or preeclampsia without severe features before 37 should have
    • Monitoring for symptoms,
    • Instruction on daily kick counts,
    • Twice weekly blood pressure measurement,
    • Blood drawn to assess platelet count, liver enzymes (AST, ALT) , and serum creatinine at least every week .
    • Ultrasound to evaluate the baby's  growth should be performed every three weeks,
    • Amniotic fluid level should be checked at least once per week,
    • Patients with GHTN should also have their blood pressure taken,  urine checked for protein,  and nonstress tests (NSTs) once weekly.
    • Patients with preeclampsia without severe features should have NSTs twice weekly.
    • Strict bedrest or a low sodium diet are not recommended.
    • Patients should be hospitalized if they develop severe hypertension, severe features of preeclampsia, or fetal growth restriction.

    REFERENCES :http://www.obfocus.com/high-risk/Preeclampsia.htm
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