Preeclampsia or Pregnancy toxemia
What is preeclampsia or pregnancy toxemia?
Preeclampsia or toxemia of pregnancy is defined by the development or worsening of high blood pressure linked with a rise in proteinuria (increase in the amount of protein in the urine) from the 20th week of amenorrhea. Postpartum preeclampsia is the term for preeclampsia that occasionally appears later or even after birth. Preeclampsia affects roughly 5% of pregnancies, or approximately 40,000 pregnancies every year in France. A third of extremely preterm births are also caused by it. It is the second largest cause of maternal death and one of the main causes of intrauterine development retardation.
The majority of preeclampsia cases do not worsen, but in a small number of cases, severe symptoms like seizures may occur, endangering the mother's and the unborn child's lives.
Preeclampsia: what causes it?
Preeclampsia appears to be associated with placental malfunction. Immunological factors, genetic factors (a genetic predisposition), placental factors (multiple pregnancies promote ischemia), environmental factors (calcium deficiency, stress, etc.), or even metabolic factors (insulin resistance, etc.) are some of the risk factors that contribute to the development of preeclampsia.
As soon as the placenta is in situ, it looks to be dysfunctional (presence of poorly developed placental arterioles, etc.): this is considered to be aberrant in placental perfusion. The placenta then discharges debris and harmful elements into the maternal bloodstream, which contribute to the increase in blood pressure. The fetus obtains less oxygen and nutrients as a result of the placenta's inability to perform its function, while waste and carbon dioxide are less effectively expelled. After that, the fetus can experience intrauterine growth retardation.
How can preeclampsia manifest itself during pregnancy or after giving birth?
A number of symptoms, including excruciating headaches, impaired vision, vomiting, tinnitus, or edema (hand and foot swelling), might be signs of preeclampsia. Severe epigastric stomach discomfort, especially in the right hypochondrium, is another symptom of preeclampsia.
What are HELLP syndrome and eclampsia, and what are the dangers and implications of preeclampsia?
Eclampsia and the emergence of HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) syndrome are the two main risks of consequences from preeclampsia. A severe seizure brought on by elevated intracranial pressure is called eclampsia. In addition to causing seizures, eclampsia can result in placental abruption, cerebral hemorrhage, and renal failure. Hemolysis, liver inflammation, and thrombocytopenia (few platelets) are the outcomes of HELLP syndrome.
How does one diagnose preeclampsia?
Preeclampsia can occasionally be diagnosed in women with high blood pressure who do not have proteinuria. The diagnosis is made based on the presence of protein in the urine, blood pressure readings above 140/90 mmHg, and a protein level in the urine exceeding 300 mg in a 24-hour period.
When thrombocytopenia, renal failure, and pulmonary edema are linked to elevated blood pressure, they may indicate preeclampsia. Preeclampsia is also diagnosed by indicators of fetal distress, such as aberrant vascular irrigation, intrauterine growth retardation, and a decrease in amniotic fluid volume. If preeclampsia is confirmed, a urea dosage, liver function investigation, or complete blood count can be carried out.
Although preeclampsia can occur in any pregnancy, some variables make it more likely to occur. Preeclampsia risk factors include having a BMI of more than 30 kg/m2, getting pregnant before the age of 18 or after the age of 40, having an autoimmune condition, or having a family history of preeclampsia. Additionally, there is a higher chance of developing preeclampsia during a first pregnancy. PGF (placenta growth factor) and SFLT1 are two indicators that can be used to forecast the risk of preeclampsia in high-risk pregnancies.
What are preeclampsia treatments?
The patient who exhibits preeclampsia symptoms will first be treated and admitted to the hospital. Both her baby's and her own vital signs will be examined. In most cases, hypotensive medication combined with bed rest and routine infant parameter monitoring is adequate. Aspirin is currently the preferred treatment for preeclampsia because it improves the vascular network and lowers coagulation. This medication can start as early as the 12th week of pregnancy and is typically given to high-risk mothers. Until delivery, treatment must be continued.
Magnesium sulfate therapy may be used to stop seizures if the illness worsens and develops into eclampsia.
Delivery and placenta delivery are the main ways to prevent major problems in severe types. When amenorrhea has progressed past 37 weeks of pregnancy and there are indications of severe preeclampsia or eclampsia, it is frequently advised to have a premature delivery. Following delivery, the mother will be under careful observation.
