Preeclampsia and eclampsia: what is it, symptoms, treatment, prognosis

What are preeclampsia and eclampsia?

Preeclampsia and eclampsia - part of the spectrum of blood pressure disorders or hypertension that occur during pregnancy and the postpartum period.

On the lighter end of the spectrum is gestational hypertensionwhich occurs when a woman who previously had normal blood pressure develops high blood pressure for gestational age over 20 weeks, and her blood pressure returns to normal within 12 weeks after giving birth. This problem usually occurs without other symptoms. In many cases, gestational hypertension does not harm the mother or fetus. However, severe gestational hypertension can be associated with preterm birth and infants who are small for their age at birth. Some women with gestational hypertension later develop preeclampsia.

Preeclampsia is similar to gestational hypertension in that it is also associated with an increase in blood pressure of 20 the week of pregnancy or after in a woman whose blood pressure was normal before pregnancy. But preeclampsia can also involve a blood pressure of 140/90 mmHg. Art. or higher, increased swelling and protein in the urine. The condition can be serious and is the leading cause of premature birth (before 37 weeks of gestation). If preeclampsia is severe enough to affect brain function, causing seizures, or whatever, it is called 

eclampsia.

A serious complication of hypertensive disorders during pregnancy is HELLP syndrome - a situation in which a pregnant woman with preeclampsia or eclampsia suffers from damage to the liver and blood cells. The letters in the HELLP name indicate the following problems:

• H - hemolysis (hemolysis), in which oxygen-carrying red blood cells (erythrocytes) are destroyed;
• EL - еlevated liver enzymes (increased activity of liver enzymes), indicating liver damage;
• LP - lоw рlаtelet сunt (thrombocytopenia), a condition characterized by a decrease in the number of platelets responsible for stopping bleeding.

Postpartum preeclampsia Is preeclampsia that develops after the baby is born, usually between 48 hours and 6 weeks after birth. Symptoms may include high blood pressure, severe headache, visual changes, upper abdominal pain, and nausea or vomiting. Postpartum preeclampsia can occur regardless of whether the woman had high blood pressure or preeclampsia during pregnancy.

Postpartum eclampsia Is a seizure that occurs between 48 and 72 hours after delivery. Symptoms also include high blood pressure and shortness of breath. About one third of eclampsia cases occur after delivery, and almost half of these occur more than 48 hours after delivery.

Causes and risk factors

The causes of preeclampsia are unknown. Previously it was thought that the disorder was caused by a toxin in the blood called "toxemia", but now medicine knows that this is not true. However, preeclampsia is sometimes referred to as "toxemia".

To learn more about preeclampsia and eclampsia, scientists are investigating many factors that may contribute to the development and progression of these diseases, including:

• placental abnormalities such as insufficient blood flow;
• genetic factors;
• environmental impact;
• nutritional factors;
• maternal immunology and autoimmune diseases;
• cardiovascular and inflammatory changes;
• hormonal imbalance.

- Who is at risk for preeclampsia?

Although preeclampsia of pregnancy occurs primarily during the first pregnancy, a woman who has preeclampsia was during a previous pregnancy, the likelihood of developing the disorder at a later date in 7 times higher.

Other factors that can increase a woman's risk include:

• Chronic high blood pressure or kidney disease before pregnancy.
• High blood pressure or preeclampsia in an earlier pregnancy.
• Obesity. Overweight women or obese more often suffer from preeclampsia in more than one pregnancy.
• Age. Women over the age of 40 are at a higher risk of the disorder.
• Multiple pregnancy (pregnancy with more than one fetus).
• African American ethnicity. In addition, among women who have previously had preeclampsia, non-white women are more likely to develop preeclampsia again later in life than whites.
• Family history of preeclampsia. According to the World Health Organization, among women who have had preeclampsia, 20% to 40% of their daughters and 11% to 37% of their sisters also suffer from the disease.

Preeclampsia is also more common in women who have a history of certain health conditions, such as migraine, diabetes, rheumatoid arthritis, lupus erythematosus, scleroderma, urinary tract infections, gum disease, polycystic ovary syndrome, multiple sclerosis, gestational diabetes and sickle cell anemia.

Preeclampsia is also more common in pregnancy as a result of egg donation, donor insemination, or extracorporeal fertilization.

Signs and symptoms

— Preeclampsia.

Possible symptoms of preeclampsia include:

• high blood pressure;
• too much protein in the urine;
• edema the woman's face and hands (a woman's legs may also swell, but swelling of the legs is common during pregnancy and may not indicate a problem);
• systemic problems such as headache, blurred vision, and pain in the right upper quadrant of the abdomen.

- Eclampsia.

The following symptoms are of immediate concern:

• convulsions;
• Strong headache;
• vision problems, such as temporary blindness;
• abdominal pain, especially in the right upper abdomen;
• nausea and vomiting;
• small diuresis or very frequent urination.

- HELLP syndrome.

HELLP syndrome can lead to serious complications including liver failure and death.

A pregnant woman with HELLP syndrome is prone to bleeding or bruising and / or experiences abdominal pain, nausea, vomiting, headache, or extreme fatigue. Although most women who develop HELLP syndrome already have high blood pressure and preeclampsia, sometimes this syndrome is the first sign. In addition, HELLP syndrome can occur without high blood pressure or protein in a woman's urine.

Complications

- Complications during pregnancy.

Preeclampsia during pregnancy is mild in most cases. However, the disease can progress rapidly from mild to severe preeclampsia or complete eclampsia - even within a few days. Both preeclampsia and eclampsia can cause serious health problems for the mother and baby.

Women with preeclampsia are at increased risk of damage to the kidneys, liver, brain, and other organs and blood systems. Preeclampsia can also affect the placenta. The condition leads to separation of the placenta from the uterus (called placental abruption), premature birth, loss of pregnancy, or stillbirth. In some cases, preeclampsia leads to organ failure or stroke.

In severe cases, preeclampsia develops into eclampsia, including seizures. Convulsions with eclampsia can lead to loss of consciousness and uncontrollable twitching of the woman. If the fetus is not born, these conditions can cause death of the mother and / or fetus.

Although most pregnant women in developed countries experience preeclampsia, it remains the leading cause of illness and death worldwide. According to the World Health Organization, preeclampsia and eclampsia are responsible for 14% of maternal deaths annually, or 50,000–75,000 women worldwide.

- Complications after pregnancy.

In “uncomplicated preeclampsia,” the mother's high blood pressure and other symptoms usually return to normal within 6 weeks after the baby is born. However, studies have shown that women with preeclampsia are four times more likely to develop hypertension (high blood pressure) and twice as likely to develop coronary heart disease (decreased blood supply to the heart muscle, which can cause heart attack), blood clots, stroke, as in women who did not have preeclampsia.

Less commonly, mothers who have had preeclampsia may experience permanent damage to their organs, such as the kidneys and liver. They also have fluid in their lungs. In the first days after childbirth, women with preeclampsia remain at increased risk of developing eclampsia and seizures.

Some women develop preeclampsia between 48 hours and 6 weeks after giving birth, a condition called postpartum preeclampsia. Postpartum preeclampsia can occur in women who have had pre-eclampsia during pregnancy and those who have not. One study found that just over half of women who had postpartum preeclampsia did not have preeclampsia during pregnancy. If a woman has seizures within 72 hours of giving birth, she may have postpartum eclampsia. It is important to recognize and treat postpartum preeclampsia and eclampsia because the risk of complications can be higher than if these conditions occurred during pregnancy. Postpartum preeclampsia and eclampsia can progress very quickly without treatment and can lead to stroke or death.

- Complications of the fetus.

Preeclampsia can be associated with problems with the placenta during early pregnancy. Such problems pose a risk to the fetus, including:

• Lack of oxygen and nutrients, which can impair the growth of the fetus.
• Premature birth.
• Stillbirth if placental abruption (separation of the placenta from the wall of the uterus) results in severe bleeding in the mother.
• Infant death.

Stillbirth is more likely if the mother has a more severe form of preeclampsia, including HELLP syndrome.

Babies whose mothers have had preeclampsia are also at increased risk of future problems, even if they are born full-term (39 weeks gestation). Babies born prematurely due to preeclampsia face a higher risk of some long-term health problems, mainly associated with early birth, including disorders learning, cerebral paralysis, epilepsy, deafness and blindness. Premature babiesmay also be hospitalized long after birth and may be smaller than full-term babies. Babies with poor growth of the uterus may later be at increased risk of developing diabetes mellitus, congestive heart failure and high blood pressure.

Diagnostics

The health care provider will check the pregnant woman's blood pressure and urine at each antenatal visit. If blood pressure is considered high (140/90 or higher), especially after the 20th week of pregnancy, the doctor, will most likely do blood tests and more extensive laboratory tests to look for protein in urine (so called proteinuria), as well as other symptoms.

Treatment

Most women with preeclampsia and eclampsia are hospitalized. Women with severe preeclampsia or eclampsia are often referred to a specialized hospital or intensive care unit (ICU).

Labor is the best treatment for preeclampsia, but the doctor must weigh the risk of preterm birth versus the severity of preeclampsia.

When needed, women are first treated with drugs to lower blood pressure (antihypertensive drugs) and drugs to control seizures. Then, urgent labor is usually carried out in the following situations:

• pregnancy lasting 37 weeks or more;
• eclampsia;
• severe preeclampsia if the pregnancy is 34 weeks or more;
• worsening organ damage in a woman;
• GPNUT syndrome;
• fetal problems.

If labor can be safely delayed when the pregnancy is less than 34 weeks, the woman is given corticosteroids to help the fetus's lungs to mature.

- Preeclampsia, which does not cause severe symptoms.

If preeclampsia of pregnancy does not cause severe symptoms, the woman is advised to change her regimen. For example, she is advised to stop working whenever possible, sit for most of the day, and avoid stress. Also, a woman with this complication should see a doctor at least once a week.

However, most women with preeclampsia are hospitalized at least initially. In the hospital, they are carefully monitored to make sure that there is no risk of serious problems in the woman and the fetus. These women may be able to go home, but they should see their doctor frequently. If they go home, they should go to the doctor's office at least once a week for a non-stress test. During the non-stress test, the fetal heart rate is electronically monitored at rest and during fetal movements. Amniotic fluid volume is measured at least once a week. Blood tests are usually done once a week to check for preeclampsia.

If preeclampsia does not become severe, labor is usually induced and the baby is delivered at 37 weeks.

- Severe preeclampsia and eclampsia.

Once severe preeclampsia or eclampsia is diagnosed, magnesium sulfate is given intravenously to the woman to prevent or stop seizures.

If seizures continue after magnesium sulfate is given, an anticonvulsant (diazepam or lorazepam) is given intravenously. Also, women may be prescribed a drug to lower blood pressure (hydralazine or labetalol). The listed drugs are administered intravenously.

The baby can be delivered by caesarean section, which is the fastest way if the cervix has not yet dilated enough for a quick vaginal delivery. Urgent delivery reduces the risk of complications in the woman and the fetus. If the gestational age is at least 34 weeks, in case of a diagnosis of preeclampsia, delivery is recommended.

Up to 34 weeks, women can be followed, usually in a hospital, if doctors believe this is safe. In such cases, the woman may be injected with a corticosteroid to help the fetus's lungs mature.

If HPNUT syndrome develops, delivery is carried out immediately, regardless of the gestational age.

- After delivery.

After giving birth, a woman who has had severe preeclampsia or eclampsia is given magnesium sulfate for 24 hours and is closely monitored because she is at increased risk of seizures. Magnesium sulfate may or may not be administered to women without severe preeclampsia.

After women stop taking magnesium sulfate, or if they have not taken magnesium sulfate, women can return to an activity they can tolerate well.

The length of hospital stay depends on whether complications develop. Most pregnant women do well after giving birth and can usually go home 2 days after giving birth through the vagina or 3-4 days after having a caesarean section. Some women may need antihypertensive drugs for the entire 6 weeks after childbirth or part of it (called the postpartum period), depending on the level of their arterial pressure.

Most women who have had preeclampsia or eclampsia should see their doctor at least once every 1 to 2 weeks after giving birth, in addition to their scheduled 6-week visits. If blood or urine test results are not within normal range, tests should be repeated at the 6-week visit. If the results continue to be abnormal, the woman may be referred to a specialist.

If blood pressure is still high 6 to 8 weeks after birth, the problem may be chronically high blood pressure (hypertension). In such cases, the woman should see an internal medicine specialist or general practitioner.

In future pregnancies, taking a low dose of aspirin (baby aspirin) once a day starting in the 1st trimester may reduce the risk of preeclampsia recurrence.

Prophylaxis

Identifying and treating preeclampsia is critical to reducing the risk of eclampsia. It is recommended that you regularly check your blood pressure during pregnancy to check for preeclampsia. Appropriate management of women with the disease usually includes the use of magnesium sulfate to prevent eclamptic seizures. In some cases, low-dose aspirin has been shown to reduce the risk of preeclampsia in pregnant women, especially when taken in the late first trimester.

Forecast

The prospects for a full recovery from preeclampsia are very good. For most women, improvement occurs within one to two days after childbirth, and blood pressure in almost all cases returns to normal pre-pregnancy levels over the next one to six weeks. However, for some women, there is still a risk of complications during this time.

About one in every five women with preeclampsia during their first pregnancy will have preeclampsia during their second pregnancy. Women with early or severe preeclampsia, or those with other medical conditions, such as high blood pressure or diabetes, are at the greatest risk of relapse.

Women who have had preeclampsia later in life are at risk of developing high blood pressure and other cardiovascular diseases.