What Is Preeclampsia? What Causes Preeclampsia?

Date: Oct-26-2012Preeclampsia, also written pre-clampsia, is a condition during pregnancy when there is a sudden, sharp rise in blood pressure, swelling (edema) and albuminuria (excess protein albumin leaks into the urine). Swelling tends to occur in the face, hands and feet.

Preeclampsia is the most common complication that can occur during a pregnancy. It generally develops during the third trimester and affects about 1 in every 20 pregnancies.

Women in their first pregnancy have a higher risk of developing preeclampsia, as do patients with diabetes and mothers carrying twins. Some women have preeclampsia in every pregnancy; experts are not sure why.

If the preeclampsia remains untreated, it can develop to eclampsia, in which the mother can go into convulsions, coma and can even die. Complications from preeclampsia are extremely rare if the mother attends her pre-natal appointments.

Preeclampsia can have some long-term consequences for the developing baby. High blood pressure in pregnant women may affect the baby's thinking skills which can carry through for many years, researchers from the University of Helsinki, Finland, reported in the journal Neurology, October 2012.

Whether or not exercise is good for women at risk of preeclampsia has been a controversial subject for many years. Researchers from the University of North Carolina at Chapel Hill School of Nursing found that stretching exercises may help reduce the risk of preeclampsia.
What are the signs and symptoms of preeclampsia?
Early signs usually include:
Hypertension (high blood pressure)
Proteinuria (protein in the urine)

In the majority of cases, the mother will not be aware of these signs, and will find out when the midwife, nurse, GP (general practitioner, primary care physician) or obstetrician picks them up during an antenatal visit.

Although between 10% and 15% of all pregnant women experience hypertension, it does not necessarily mean they have preeclampsia. The most telling sign is the presence of protein in the urine.

As the preeclampsia progresses the mother can experience edema (fluid retention), with swelling in the hands, feet, ankles and face.

Swelling is a common part of pregnancy anyway, especially during the third trimester, and tends to occur in the lower parts of the body, such as the ankles and feet. Symptoms are usually milder first thing in the morning, and build up during the day. This is not preeclampsia, in which edema occurs suddenly and tends to be much more severe.







Later on, the following signs and symptoms may develop:
blurry vision, sometimes seeing flashing lights
headaches, often severe
malaise
pain just below the ribs
rapid weight gain (caused by edema)
vomiting

The main sign of preeclampsia in the fetus is poor growth, because the blood supply to the placenta is restricted.
What are the causes of preeclampsia?
Experts are not sure why preeclampsia occurs. Most say that there is a problem with the proper development of the placenta, because the blood vessels that supply it are faulty.

How might the placenta affect blood pressure?

The mother's blood supply links to the unborn baby's via the placenta. All the baby's oxygen and nutritional requirements go through the placenta. The baby's waste products travel the opposite way, through the placenta, to the mother.

As the baby grows, the amount of blood that passes through the placenta increases.

In preeclampsia, the food supply to the placenta is inadequate; possibly because the placenta itself has not developed properly during the pregnancy.

The placenta may not have developed properly because early on in the pregnancy, tiny blood vessels (villi) which form within the placenta should eventually turn into arteries. If they do not transform fully into arteries, the placenta will not develop as it should because it is not receiving enough nutrients. Nobody knows why the blood vessels do not transform into proper arteries.

If the placenta is not functioning properly, the extra blood supply that should be pushing through from the mother will not go through, causing hypertension, swelling and possibly kidney problems. She cannot eliminate waste products fast enough and they build up in her blood, while certain vital proteins that should stay in the bloodstream leak into her urine, causing proterinuria.

An overabundance of a gene linked to the regulation of the body's immune system was discovered in the placentas of women who suffered preeclampsia during their pregnancy. The researchers, from North Carolina State University said that their discovery may lead the way to better screening and prenatal care.

Pregnant women who are exposed to traffic air pollution have a greater risk of developing preeclampsia compared to pregnant women of the same age who are not exposed, researchers from the University of California, Irvine, reported in Environmental Health Perspectives, June 2009 issue.
What are the risk factors linked to preeclampsia?
Risk factors are situations, conditions or environments which increase the chances of developing a disease, disorder or condition. For example, obesity is a risk factor for diabetes type 2 (if you are obese, your risk is greater for developing diabetes type 2).

Risk factors associated with preeclampsia include:
First pregnancies - the chances of preeclampsia during a first pregnancy are considerably higher than the subsequent ones

Pregnancy gap - if the second pregnancy occurs at least ten years after the first, that second pregnancy has a higher risk of preeclampsia

Family history - a woman whose mother or sister had preeclampsia, has a higher risk of developing it herself

Personal history of preeclampsia - a woman who had preeclampsia in her first pregnancy, has a much higher risk of having the same condition in her subsequent pregnancies

Age - women over 40 and teenagers are more likely to develop preeclampsia compared to other ages

Certain conditions and illnesses - women with diabetes, hypertension, migraines and kidney disease are more likely to develop preeclampsia

Obesity - preeclampsia rates are much higher among obese women

Multiple pregnancies - if you are expecting at least two babies, your risk is higher

How is preeclampsia diagnosed?
For a diagnosis of preeclampsia to be made, both these tests must come back positive:
Hypertension - the woman's blood pressure is too high.

A blood pressure reading above 140/90 mm Hg is abnormal in pregnancy.

Proteinuria - protein is detected in the urine.

Urine samples are collected over 12 hours or more and the amount of protein present is quantified. This can give an indication of the severity of the condition.

The doctor may also order some further diagnostic tests:
Blood tests - to see how well the kidneys and the liver are functioning, and whether the blood is clotting properly.

Fetal ultrasound - the baby's progress will be closely monitored to make sure he/she is growing properly.

Non-stress test - the doctor checks how the baby's heart beat reacts when he/she moves. If the heart beat increases 15 beats or more a minute for at least 15 seconds twice every twenty minutes, it is a sign that everything is probably fine.

What are the treatment options for preeclampsia?
Preeclampsia is not cured until the baby is delivered. Until the mother's blood pressure comes down, she is at a greater risk of stroke, severe bleeding, placental abruption and seizures. In some cases, especially if the preeclampsia started early, delivery may not be the best option for the fetus.

Women who had preeclampsia in previous pregnancies are advised to attend prenatal sessions more often.

The following medications may be recommended:
Antihypertensives - prescribed to lower blood pressure.

Corticosteroids - if the mother has preeclampsia or HELLP syndrome, these drugs may improve platelet and liver functioning, which prolongs the pregnancy. They also speed up the development of the baby's lungs; important if he/she is going to be born prematurely. (Usually, the best treatment for HELLP syndrome is to deliver as soon as possible)

Anticonvulsives - in severe cases, in order to prevent a first seizure, the doctor may prescribe magnesium sulfate.

Rest

If the mother is far from the end of her pregnancy and her symptoms are mild, the doctor may advise her to rest in bed, this helps bring the blood pressure down, which in turn increases the flow of blood to the placenta, which benefits the baby.

Some women are advised to just lie down in bed, and only sit up or stand when they really have to. Others may be allowed to sit on an armchair, sofa or bed, but will have their physical activities strictly limited. Blood pressure and urine tests will be carried out regularly. The baby will also be monitored closely.

In severe cases the mother may have to be hospitalized, where she will need continuous bed rest and will be monitored closely.

Inducing labor

If preeclampsia is diagnosed close to the end of the pregnancy, the doctors may advise delivering the baby as soon as possible.

In very severe cases, there may be no choice and either labor is induced or a C-section is performed as soon as possible. During childbirth, the mother may be given magnesium sulfate to improve uterine blood flow and prevent seizures.

The symptoms of preeclampsia will go away within a few weeks of delivery.
What are the possible complications of preeclampsia?
If preeclampsia is not treated, there is a risk of serious complications. Complications are rare if the mother goes to ante-natal visits. However, if the condition is not diagnosed for some reason, or she continues to smoke, the risks are considerably greater.

The following complications may develop from preeclampsia:
HELLP syndrome - this can become life-threatening very quickly, for both the mother and the baby. HELLP stands for Hemolysis, Elevated Liver enzymes and Low Platelet count. It is a combined liver and blood clotting disorder which most commonly occurs straight after giving birth, but can appear at any time after the twentieth week of pregnancy. Very rarely, it may occur beforehand. The only way to treat HELLP syndrome effectively is to deliver the baby as soon as possible.

Poor blood flow to the placenta - if blood flow to the placenta is restricted, the baby might not be getting essential oxygen and nutrients, which may lead to slower growth, breathing difficulties, and premature birth.

Placental abruption - the placenta separates from the inner wall of the uterus. In severe cases there may be heavy bleeding, which can damage the placenta. Any damage to the placenta may place the baby's and mother's life at risk.

Eclampsia - basically a combination of preeclampsia and seizures (fits). The patient may experience pain under the ribs on the right of the body, intense headache, blurry vision, confusion, and decreased alertness. If left untreated the patient is at risk of going into a coma, suffering permanent brain damage, and dying. The condition is life-threatening for the baby as well.

Cardiovascular disease - women who have preeclampsia have a higher risk of developing cardiovascular diseases later on.

Written by Christian Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today
Courtesy: Medical News Today Note: Any medical information available in this news section is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.