What happens with preeclampsia
At the beginning of pregnancy, the vessels of the uterus must rebuild to provide the placenta with blood. If this does not occur fully, the placenta experiences a lack of oxygen and releases substances into the mother’s blood that damage the inner lining of the blood vessels. As a result, the vessels narrow, pressure increases, the kidneys leak protein, and liver function and blood clotting may be disrupted. At the same time, the child receives less nutrition and may be stunted in growth.
- Moderate preeclampsia - pressure from 140/90, protein in urine
- Severe - blood pressure over 160/110 or signs of organ damage
- Eclampsia - seizures due to preeclampsia
- HELLP syndrome - destruction of red blood cells, increase in liver enzymes, drop in platelets
- It also happens after childbirth, in the first days and weeks.
Risk factors
Preeclampsia can develop in any pregnant woman, but for some women the risk is significantly higher. They are identified already during registration in order to observe more closely and, if necessary, begin prevention. It is important to tell your obstetrician-gynecologist about these factors at the first visit, even if your blood pressure is now normal.
- Preeclampsia in a previous pregnancy
- Chronic arterial hypertension
- Diabetes mellitus, kidney disease
- Autoimmune diseases, antiphospholipid syndrome
- First pregnancy, multiple pregnancy
- Age over 40, obesity, IVF
Symptoms
At an early stage, a woman may feel well, and the disease is detected only by blood pressure and urine analysis. Swelling of the legs itself occurs in many pregnant women and is not considered a sign of preeclampsia, but rapid swelling of the face and arms is alarming. The appearance of a headache, visual disturbances and pain in the upper abdomen indicates a severe course and requires urgent help.
- Increased pressure detected during measurement
- Sudden swelling of the face and hands
- Rapid weight gain in a few days
- Headache, visual disturbances
- Pain in the epigastrium or right hypochondrium
- Decreased fetal movements
Diagnostics
Blood pressure is measured at each visit, and if it increases, it is measured again at home. Protein in urine is determined in a single portion, if the result is positive - in daily urine or by the ratio of protein and creatinine. Blood tests show platelets, liver enzymes, creatinine. The child’s condition is assessed by ultrasound with Doppler and CTG. 24-hour blood pressure monitoring helps distinguish persistent hypertension from an increase at the appointment. In the first trimester, screening to assess the risk of preeclampsia is carried out in a number of centers.
- Blood pressure measurement, home diary, ABPM
- Protein in urine, protein/creatinine ratio
- Complete blood count with platelets
- ALT, AST, creatinine, LDH
- Fetal ultrasound with Doppler ultrasound
- CTG
Treatment and prevention
With confirmed preeclampsia, the pregnant woman is usually observed in the hospital. Blood pressure is reduced with medications approved during pregnancy, and in severe cases, magnesium is administered intravenously to prevent seizures. The due date is determined taking into account the condition of the mother and child: in severe cases, the birth often has to be accelerated; in moderate and full-term cases, the birth must be planned. For women at high risk, the doctor may prescribe low doses of acetylsalicylic acid from the 12th week, and with low calcium intake, calcium supplements. After birth, blood pressure is monitored for several more weeks.
- Regular blood pressure monitoring at home
- Antihypertensive drugs for pregnant women - only as prescribed
- Hospitalization with a confirmed diagnosis
- Prevention in risk groups according to the decision of an obstetrician-gynecologist
- Timely delivery
- Observation by a therapist or cardiologist after childbirth
