Preeclampsia or pre-eclampsia is a pregnancy related complication characterized by raised blood pressure and evidence of impaired functioning of at least one organ. In most of the cases usually the kidneys are damaged and it is characterized by excretion of large amount of protein in the urine.In most of the cases of preeclampsia the symptoms begin to appear after 20 weeks of pregnancy and in women who had normal blood pressure previously. Preeclampsia is a medical emergency it should be managed urgently and adequately, otherwise life threatening complications may arise affecting both the mother as well as the baby. Eclampsia is a common complication seen in preeclampsia patients without treatment. In this condition other than the features of preeclampsia episodes of convulsion (seizures) may occur.
The only known treatment of preeclampsia is delivery of the baby along with the placenta.
The underlying cause responsible for preeclampsia is not known however several theories have been put forward regarding causation and pathogenesis of preeclampsia. The most popular theory regarding preeclampsia is abnormality of the placenta (the organ which supplies oxygen and nutrients to the growing baby from mother) in regard to its function, development and structure.
During early part of the pregnancy newer blood vessels are formed which are responsible for adequate supply of oxygen and nutrients to the growing baby from the mother’s body. In preeclampsia these vessels are not developed normally leading to decreased blood supply to the growing baby and also abnormal reaction towards the alien systems.There are certain common causes associated with abnormal development of these blood vessels; these are
1) Poor blood supply to the uterus
2) Impaired immune system
3) Having certain genes
4) Damaged blood supplying.
Other than this most commonly appreciated causative causes there are immunological,hematological,environmental,etc. Also including preeclampsia, there are three other high blood pressure related conditions in pregnancy are characterized by
a) Chronic high blood pressure along with preeclampsia
b) Chronic hypertension: this is characterized by raised blood pressure usually before birth and 20 weeks of pregnancy.
c) Gestational hypertension: characterized by raised blood pressure with no symptoms of kidney damage and occurring usually after 20 weeks.
Common risk factors associated with preeclampsia are
1) Family history or past history of preeclampsia
2) First pregnancy
3) Having a new partner during different marriages and pregnancy
4) Age above 40 years
5) Excessive body weight
6) Multiple preganancy like having twins or triplets
7) Gap between two consecutive pregnancy: Usually it is seen that if the gap between two consecutive pregnancy is less than 2 years or more than 20 years.
8) Associated medical conditions: there are several conditions which may increase the risk of high plod, These are diabetes (both type 1 and type 2), impaired kidney function, migraine etc
The mainstay of treatment of preeclampsia is delivery of the baby. Delivery should be done as early as possible as there are increased risk of episodes of convulsion, stroke, bleeding etc, however if detected earlier, delivery of the baby might not be the best for the baby.
Commonly used drugs for preeclampsia are
a) Blood pressure lowering agents: As the blood pressure is raised beyond 140/90 mm of Hg.
b) Corticosteroids: these drugs are used in severe cases of preeclampsia and HELLP syndrome.
c) Anti epileptic drugs are used to prevent and treat episodes of convulsion. The most commonly used drug is magnesium sulfate.
Adequate resting is important along with hospitalization to monitor mother and baby’s health regularly.Preeclampsia diagnosed at or near the end of the term is managed by induction of labor by putting drugs or by Caesarean section.