What is Preeclampsia?
Preeclampsia is a serious pregnancy complication characterised by high blood pressure and high levels of protein in the urine that arise after 20 weeks of gestation. The high blood pressure and presence of protein in the urine are markers of a problem that may damage other maternal organs and the developing foetus. Timely treatment by a healthcare provider is necessary because preeclampsia in pregnancy can become life-threatening for both the mother and baby. Close monitoring and management of preeclampsia are essential to reduce maternal and foetal risks and to improve outcomes.
Preeclampsia imposes substantial cardiovascular strain and multi-organ dysfunction. There are two stages of preeclampsia. Firstly, the blood pressure exceeds healthy pregnancy norms and is typically over 140/90 mmHg. Proteinuria, or protein loss via the urine, signals kidney impairment and is a cardinal sign of preeclampsia. The condition can affect blood flow to the placenta, compromise liver and kidney function, and cause fluid accumulation in the lungs (pulmonary oedema).
Preeclampsia is a pregnancy-specific condition that is estimated to affect up to 8% of pregnancies globally, making it a major cause of maternal and foetal complications. Usually, there are two types of preeclampsia: mild & severe. Preeclampsia in pregnant women is also believed to be responsible for approximately 15% of premature births occurring before 37 weeks of gestation.
What Causes Preeclampsia?
The causes of preeclampsia are not identified, though placental vascular abnormalities are strongly implicated. The prevailing hypothesis is that the blood vessels supplying the placenta exhibit atypical responses to hormonal signalling during development, leading to narrower-than-normal diameters that constrain blood flow. The reasons for preeclampsia are poorly defined, and proposed contributors include vascular injury, uterine hypoperfusion, immunologic disturbances, and genetic predispositions. Meanwhile, risk stratification based on factors like prior vascular dysfunction, chronic hypertension, autoimmune conditions, and family history can help in anticipation and timely detection to mitigate adverse outcomes.
Complications
Some of the most common complications of preeclampsia for pregnant women include:
Foetal Growth Restriction
Impaired perfusion of the placenta due to abnormal placental arterial function in preeclampsia can restrict oxygen and nutrient delivery to the developing foetus. This placental insufficiency starves the foetus of vital resources needed to support normal growth and development. Consequently, the foetus is unable to reach its biological growth potential, resulting in a condition termed foetal growth restriction, in which the foetus exhibits reduced growth parameters as compared to normal foetal growth.
Preterm Birth
Preeclampsia can necessitate preterm delivery, either unintentionally due to disease progression or intentionally as a treatment modality. Babies born before 37 weeks gestation as a result of preeclampsia face risks of complications like respiratory distress, feeding problems, sensory deficits, developmental delays, and cerebral palsy. Prematurity poses significant threats to infant health and development. However, certain interventions prior to medically indicated early delivery may help mitigate some of these risks.
Placental Abruption
Preeclampsia during pregnancy elevates the risk of placental abruption, a serious complication in which the placenta detaches from the uterine wall prior to delivery. A severely abnormal separation can lead to dangerous maternal haemorrhage, posing potentially fatal threats to both the mother and foetus. Prompt diagnosis of abruption is critical to expedite emergency delivery and initiate resuscitative care when needed.
HELLP Syndrome Haemolysis – Elevated Liver Enzymes and Low Platelet Count
HELLP syndrome is a severe form of preeclampsia involving multiple organ dysfunction. By disrupting several organ systems, HELLP syndrome puts the mother and baby at grave risk of serious complications or mortality. Mothers with a history of HELLP syndrome are also susceptible to lasting health problems. Prompt diagnosis and intensive management of HELLP syndrome are essential to avoid adverse outcomes in affected pregnancies.
Eclampsia
Eclampsia refers to the new onset of seizures or coma in the setting of preeclampsia, representing a progression to a more severe, life-threatening stage. Sudden onset eclampsia without antecedent signs of preeclampsia can occur but is more difficult to predict or prevent. The unpredictability and rapid deterioration underscore the need for vigilance and prompt response to neurological symptoms in patients with preeclampsia to avoid foetal complications of eclampsia.
Cardiovascular Disease
Preeclampsia predisposes women to higher lifetime cardiovascular risk, including heart disease and blood vessel disorders. This susceptibility is further elevated for those with recurrent preeclampsia across pregnancies or those whose preeclampsia results in preterm delivery.
Management and Prevention
For women who develop preeclampsia close to full term (37+ weeks gestation), delivery is often recommended as treatment, whether by induction of labour or caesarean if indicated. Medications may be prescribed pre-delivery to promote foetal lung maturity. In some cases, the risks of expectant management outweigh the benefits of further pregnancy prolongation.
Earlier in pregnancy, the priority is closely monitoring maternal-foetal health to optimize the chance of safely continuing the pregnancy, allowing more time for foetal development. This entails more frequent prenatal visits for blood pressure checks, blood tests, urinalysis, and ultrasounds. If preeclampsia is severe, hospitalization for observation may be required. Regardless of gestational timing, worsening preeclampsia necessitates delivery even if premature, as the maternal-foetal risks need intervention. Rest, it is important that expecting mothers should discuss managing preexisting conditions that may increase the risk of preeclampsia with their healthcare professional.
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