Understanding Preeclampsia: Symptoms, Causes, and Treatment

It is characterized by the presence of protein loss by urine and fluid retention during the second half of pregnancy. Blood pressure is measured with two numbers, the highest is the systolic pressure and the lower number corresponds to the diastolic pressure. Normal blood pressure values ​​are 120 systolic and 80 diastolic. If the maximum blood pressure is above 140 or the minimum is above 90, arterial hypertension is diagnosed. If, in addition to hypertension, loss of protein in the urine due to kidney disease and edema is diagnosed, preeclampsia.

Causes of preeclampsia

The causes of preeclampsia are unclear but it appears to be due to a alteration in the formation of the blood vessels of the placenta.

The main risk factors for a pregnant woman to develop pre-eclampsia are:

• Women in their first pregnancy
• Multiple pregnancies
• Over 35 years
• Previous hypertension
• Patients with immune diseases
• Family history of pregnancy hypertension

Does hypertension always cause preeclampsia?

A distinction must be made between chronic hypertension, pregnancy hypertension and pre-eclampsia. The patient chronic hypertensive It is the one already diagnosed with hypertension before pregnancy or the one that debuts with high blood pressure before 20 weeks of pregnancy. This patient may have superimposed preeclampsia if the loss of protein in the urine and edema are added to the high blood pressure figures. The patient with a pregnancy hypertension It is one that presents high blood pressure figures without any other alteration.

Finally the patient with preeclampsia It is one that presents blood pressure figures above 140 the systolic or 90 the diastolic, and also has protein losses through the urine. The way to quantify these proteins is by analyzing them in the urine for 24 hours. Edema consists of the accumulation of fluids in the body and can be measured by weight gain greater than 1 kg in a week, and by swelling of the hands and feet. In edema, if the lower extremities are squeezed with the finger, the pressure area remains white and sunken for a time until it returns to its previous state.

How Preeclampsia Is Dignostic

The most common way to diagnose preeclampsia is in women prenatal visits before symptoms occur, when it is in the asymptomatic phase. In case of presenting symptoms, it usually gives headache, abdominal pain, decreased amount of urine, nausea and vomiting and changes in vision. But there are times when preeclampsia is totally silent and the pregnant woman does not have any symptoms. Preeclampsia can cause damage to the innermost layer of the blood vessels of the pregnant woman's kidney, leading to kidney failure or damage to the vessels of the retina. In case of altering the blood vessels of the brain, it can give seizures at which time it is called eclampsia.

Classification

Preeclampsia can be classified as: mild pre-eclampsia if the blood pressure is between 140/90 and 160/110 and proteinuria of less than 2 grams in 24 hours, or in severe pre-eclampsia if the blood pressure is greater than 160/110 or proteinuria of more than 2 grams in 24 hours. Eclampsia is the most serious form and manifests as severe seizures of sudden onset, due to damage to the cerebral blood vessels.

Treatment

Treatment of preeclampsia depends on the length of pregnancy and the severity of the clinical picture. The only way to cure it is to end the pregnancy, but in cases of prematurity, conservative treatment is tried as long as the maternal state allows it. The route of delivery does not have to be one and an induction of labor can be performed in cases where there is no other contraindication to a vaginal delivery.

In mild pre-eclampsias, treatment may be considered domiciliary, with blood pressure controls and, according to the results, taking medication, which is usually different from that administered in non-pregnant women and some of the medications are contraindicated during pregnancy. Home rest should be done and the salt-free diet has not been shown to lower blood pressure.

If the fetus is not yet mature, the administration of corticosteroids intramuscular to the mother to accelerate fetal lung maturation and thus minimize the risks of probable removal of the fetus before term. Complications for the fetus are determined above all by the prematurity that may be associated, in addition to the high frequency of fetuses with a growth that is lower than expected due to an alteration in the placental blood vessels.

If the maternal situation requires it, it should be fthe pregnancy ends regardless of the time of pregnancy. The most severe maternal complications are kidney damage, liver failure, and seizures. If these complications evolve they can lead to coma and maternal death. Treatment includes prevention of complications and to prevent seizures, magnesium sulfate administered intravenously is used. This treatment should be maintained up to 48 hours postpartum since the risk remains during this time.

The HELLP syndrome it can be a complication of pre-eclampsia although it can appear without previous pre-eclampsia. Its acronyms respond to the pathology that it produces since it is characterized by Hemolysis (breakdown of blood cells), EL (elevation of liver enzymes, transaminases), and LP (low level of platelets). It is a very serious complication since there is a severe alteration of coagulation and failure of liver function. Treatment is the termination of pregnancy regardless of the length of pregnancy. The risk that a woman who has had a HELLP in one pregnancy will repeat it in the next pregnancy is approximately 30% if the condition began after 32 weeks of pregnancy.