Pre-Eclampsia (Toxemia)

There are several pregnancy-related hypertension conditions that can be detected through blood pressure and urinalysis during pregnancy monitoring. One such condition, which is characterized by an increase in blood pressure and occurs after the 20th week of pregnancy, is called pre-eclampsia. Despite the deterring name, you will probably be relieved to learn that pre-eclampsia resolves after childbirth. The condition is more common, but not unique, in first-time mothers, those with a family history of rep-eclampsia, or those who have experienced pre-eclampsia before the 32nd week of a previous pregnancy. Additional medical conditions, such as births, obesity, kidney disease, or chronic hypertension, increase the probability of pre-eclampsia.

There are various theories regarding the cause of this condition. However, recent studies believe that pre-eclampsia is caused by the secretion of a certain protein into the blood stream of the mother’s body, which causes damage to her blood vessels.

Frequency and risk factors of pre-eclampsia

• First childbirth.
• Pre-eclampsia in a previous pregnancy.
• Chronic hypertension or a basic kidney disease
• History of blood clotting disorders (thrombophilia), mainly type APLA.
• Multiple birth.
• Pregnancy after fertility treatments.
• Family history.
• Diabetes type 1 or 2.
• Obesity.
• Lopus.
• Age 40 and over.

Warning signs for detecting pre-eclampsia

While pre-eclampsia is often discussed, it is still relatively uncommon, and it may categorize a pregnant woman as having a "high-risk pregnancy. This condition is characterized by hypertension and excess protein in the urine, resulting in multi-system damage to the mother’s blood vessel walls. This damage may lead to increased blood pressure, causing harm to various organs, including the kidneys, liver, and brain. Impaired blood flow to the placenta can affect the growth of the fetus.

Women who suffer from pre-eclampsia may encounter severe headaches, blurred vision, dizziness, and acute pain in the upper abdomen that does not respond to treatment and lacks any other apparent cause. Additional symptoms may include sudden swelling of the arms and face that persists even after rest as well as rapid weight gain (more than half a kilo per day). While these conditions can serve as warning signs, they can also occur in normal pregnancies.

Medicine categorizes pre-eclampsia into various degrees of severity. The most extreme degree can lead to seizures, liver function disorders, and, very rarely, maternal mortality. One of the most severe complications for the mother is HELLP syndrome, which involves the breakdown of red blood cells, liver function disorders, and a decrease in platelet count. This syndrome is life-threatening. The earlier pre-eclampsia develops during pregnancy, the more it can impact fetal growth.

The connection between regular antenatal care and pre-eclampsia

Medical professionals stress the significance of regular antenatal care appointments for pregnant women. These appointments include measurements of urinary protein levels and blood pressure, particularly in early pregnancy. This screening is crucial for detecting early blood pressure elevation and the development of pre-eclampsia. It is even more important after the 20th week. However, it is important to point out that not every increase in blood pressure leads to pre-eclampsia.

When you attend a screening or follow-up examination with a nurse during your pregnancy, you will be asked to undergo blood pressure and urine protein tests.

• Blood pressure measurement is performed while sitting down after at least a ten-minute rest and the use of an appropriate arm sleeve.
• A normal blood pressure reading is under 140/90 mm Hg.

Approaches to treating pre-eclampsia

You will probably be relieved to learn that pre-eclampsia resolves after childbirth. Treatment prior to labor depends on the disease's severity and the stage of pregnancy. Conservative management involves blood pressure control and ongoing monitoring of both you and your fetus. In severe cases, the medical team will decide on intervention and induced labor.

Mild pre-eclampsia: treatment includes close monitoring of blood pressure with the aim of reaching full-term pregnancy (37 weeks). Medications to reduce blood pressure are usually unnecessary unless it is consistently high (above 110/160). Normal childbirth is feasible, and occasionally, induced labor may be recommended to expedite delivery.

Severe pre-eclampsia: early pre-eclampsia, before the 34th week of pregnancy, is usually categorized as severe. This means you will have to be hospitalized for close monitoring of both the mother and fetus. If there is an elevated risk and a need for induced premature labor, doctors may recommend steroid injections to promote fetal lung maturity. In certain cases, doctors may recommend intravenous magnesium sulfate treatment to reduce the risk of seizures. This treatment involves the insertion of a urinary catheter to monitor the mother’s urine output and vital signs. The treatment is administered in a delivery room, under midwives' supervision, and in conditions similar to intensive care. While normal childbirth is often possible, the medical staff will determine the timing and method of delivery based on the circumstances, severity, and stage of pregnancy.

Late-onset pre-eclampsia: this condition typically occurs after the 34th week of pregnancy and often necessitates labor induction as a medical intervention.

Ongoing follow-up recommendations for the patient

Pre-eclampsia resolves after childbirth, and the symptoms gradually vanish. New birthing mothers are discharged with the newborn and with recommendations for further follow-up based on the severity of their condition. Overall, mothers who have had pre-eclampsia must avoid factors that increase the risk of cardiovascular diseases, such as obesity, smoking, physical inactivity, diabetes, and high cholesterol. In severe cases of pre-eclampsia, high-risk pregnancy follow-up and early aspirin treatment may be recommended, starting as early as the 12th week of pregnancy.

• If you have been diagnosed with early pre-eclampsia, you face a continuous high risk of vascular diseases, including coronary artery disease, strokes, and renal failure. This elevated risk requires ongoing medical follow-up after childbirth.
• For those diagnosed with severe pre-eclampsia who have undergone induced labor before week 34, an acquired thrombophilia screening is recommended at the end of the post-partum period.