Preeclampsia Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Preeclampsia is a complication during pregnancy characterized by blood pressure reaching 140/90 mmHg.
Usually, preeclampsia occurs after the pregnancy enters the age of 20 weeks (late second to third trimester).
Preeclampsia is also considered a condition that most often precedes eclampsia, which is a condition of pregnancy accompanied by seizures due to high blood pressure.
If not treated immediately, preeclampsia can be fatal for both the mother and the fetus. Such as imperfect fetal development, premature birth, to death.
Preeclampsia Symptoms
Preeclampsia is divided into two categories based on its severity.
The two categories are mild preeclampsia and severe preeclampsia. The signs and symptoms caused by the four are not the same.
In mild preeclampsia, recognizable symptoms include:
- Blood pressure rise up to 140mmHg/90mmHg – ≤160mmHg/110mmHg
- Proteinuria, namely the presence of protein in the urine examination
- Edema (fluid accumulation) in the calves, abdomen, back, face or hands
Severe preeclampsia is a pregnancy complication characterized by:
- Blood pressure ≥160mm / ≥110mmHg
- Increased levels of liver enzymes
- Oliguria (400 ml/24 hours)
- Proteinuria (protein in urine 3g/l)
- Heartburn
- Visual disturbances or severe frontal headache
- Bleeding in the retina (part of the eye)
- Edema (fluid accumulation) in the lungs
Preeclampsia Reason
The cause of preeclampsia is still not known with certainty. However, preeclampsia is suspected to be caused by the placenta.
The placenta is a collection of blood vessels that connects the fetus and mother. In early pregnancy, these new blood vessels develop rapidly to supply oxygen and nutrients to the placenta.
In women with preeclampsia, these blood vessels don’t appear to develop or function properly.
These vessels are narrower than normal and react differently to hormone signals. In the end, this makes blood pressure higher and unstable.
Preeclampsia is a disorder caused by high blood pressure (hypertension) that can occur during pregnancy.
In addition, several other disorders can also have an impact on preeclampsia, such as:
- Gestational hypertension is high blood pressure that begins after 20 weeks without any problems with the kidneys or other organs. Some women with gestational hypertension develop preeclampsia.
- Chronic hypertension is high blood pressure that occurs before pregnancy or occurs before 20 weeks of gestation.
High blood pressure that lasts more than three months after pregnancy is also called chronic hypertension.
- Chronic hypertension with superimposed preeclampsia occurs in women who were diagnosed with chronic high blood pressure before pregnancy. Later, the condition worsens and there is a protein in the urine or other health complications during pregnancy.
Risk Factors
Conditions that can trigger a higher risk of preeclampsia include:
- History of preeclampsia in a previous pregnancy
- Pregnant with more than one baby
- Chronic high blood pressure (hypertension)
- Type 1 or type 2 diabetes before pregnancy
- Kidney disease or disorder
- Autoimmune disorders
- Use of in vitro fertilization
- Obesity
- Family history of preeclampsia
- Age 35 or older at the time of pregnancy
- Complications in previous pregnancies
- More than 10 years since the previous pregnancy
Diagnosis
Pregnant women are expected to have their wombs checked regularly. This can help the diagnosis process be carried out more quickly.
Because, when carrying out an obstetric examination, the doctor will also check blood pressure.
If abnormalities are found, handling can be done as soon as possible.
Here are some examinations that doctors may do to detect preeclampsia:
- The diagnosis of preeclampsia can be made by looking for symptoms on a physical examination.
The main thing to note is the increase in systolic blood pressure of 140 mmHg – ≤160 mmHg and diastolic which reaches 90 – ≤110 mm
- In addition, laboratory tests (urine) are also needed to see proteinuria
The goal is to find out if there is protein in the urine. Another thing to check is whether there is edema (accumulation of fluid) in the calves, abdomen, back, and face or hands
- From laboratory tests, a complete blood count or CBC can be done to look for abnormal blood cell counts
For example, a platelet count that is less than 100,000 (thrombocytopenia) or an elevated liver enzyme count
- Meanwhile, an ultrasound examination is needed to determine the condition of the fetus due to preeclampsia
Your doctor will likely recommend closely monitoring your baby’s growth via ultrasound
- Non-stress test or biophysical profile. A non-stress test is a simple procedure that checks how the baby’s heart rate reacts when the mother moves.
A biophysical profile uses ultrasound to measure a baby’s breathing, muscle tone, movement, and the volume of amniotic fluid in the mother’s uterus
Preeclampsia Treatment
Treatment of preeclampsia is carried out according to the symptoms that appear. In mild preeclampsia, treatment can be done on an outpatient basis (ambulatory) or inpatient (hospitalization).
Handling can be adjusted to the wishes and conditions of pregnant women.
Lifestyle Changes
You may need a special diet or reduced salt consumption. However, it is necessary to pay attention to nutritional intake.
Doctors also may not give antihypertensive drugs. However, you still need to carry out routine checks.
Monitoring in the Inpatient Room
Meanwhile, hospitalization is needed if the mother has persistent hypertension for more than 2 weeks.
Another thing that makes mothers need this treatment is if there is proteinuria that persists for more than 2 weeks.
In addition, abnormal laboratory test results and the need for regular examinations and monitoring also require hospitalization.
Regular monitoring is usually required to check blood pressure, and weight, and observe symptoms of severe preeclampsia and eclampsia.
In treatment that uses outpatient care, the mother will be allowed to go home if there is an improvement in the signs of preeclampsia or the gestational age has reached 37 weeks or less.
However, pregnant women still need to be observed.
In severe preeclampsia, complications of pregnancy are characterized by the emergence of high blood pressure of 160/110 mmHg or more accompanied by proteinuria and/or edema at 20 weeks of gestation or more.
Treatment can be done based on gestational age and the development of symptoms of severe preeclampsia.
Administration of Drugs
Treatment that can be done is active care. This means that the pregnancy must be terminated immediately (termination of pregnancy). Mothers also need certain medicines.
Meanwhile, conservative treatment is carried out while maintaining pregnancy with the help of certain drugs, including:
- Antihypertensive drugs to lower blood pressure
- Anticonvulsant medications, such as magnesium sulfate, to prevent seizures
- Corticosteroids to improve your baby’s lung development before delivery
Prevention
Clinical evidence for the prevention of preeclampsia is the use of low-dose aspirin.
Doctors may recommend taking 81-milligram aspirin tablets every day after entering 12 weeks of gestation if the mother has one high-risk factor for preeclampsia or more than one moderate risk factor.
During pregnancy, especially if you’ve had preeclampsia before, it’s a good idea for mothers to maintain their health as best they can.
Talk to your treating doctor about managing any conditions that increase your risk of preeclampsia.
Consider all drug intake and supplementation that can prevent preeclampsia.
Complications
The complications of preeclampsia that may occur are quite a lot, including:
eclampsia
Eclampsia is the onset of seizures or coma with signs or symptoms of preeclampsia. It is very difficult to predict whether a patient with preeclampsia will develop eclampsia. Eclampsia can occur without any previously observed signs or symptoms of preeclampsia.
Fetal growth is stunted
Preeclampsia affects the arteries that carry blood to the placenta. If the placenta doesn’t get enough blood, the baby may receive inadequate blood and oxygen and fewer nutrients.
This can cause slow growth which is known as fetal growth retardation.
Premature Birth
Preeclampsia can cause unplanned premature birth, which is before 37 weeks.
Babies born prematurely have an increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy.
Placental Solution
Preeclampsia increases the risk of placental abruption, in which the placenta separates from the inner wall of the uterus before delivery
A severe abruption can trigger massive bleeding, which is dangerous and life-threatening to the mother and fetus.
HELLP syndrome
HELLP is hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelet count.
This severe form of preeclampsia affects multiple organ systems. HELLP syndrome threatens the safety of both mother and baby and can cause lifelong health problems for the mother.
Other Organ Damage
Preeclampsia can cause damage to the kidneys, liver, lungs, heart, or eyes, and can lead to a stroke or other brain injury.
The amount of injury to other organs depends on how severe the preeclampsia is.
Cardiovascular Disease
Having preeclampsia can raise the risk of heart disease and blood vessels in the future.
The risk is even greater if you have had preeclampsia more than once or have given birth prematurely.
When to See a Doctor?
Make sure you always do routine prenatal controls so that your healthcare provider can monitor your mother’s blood pressure regularly.
Call your doctor or go to an emergency room right away if you have a severe headache, sudden blurred vision or visual disturbances, severe stomach pain, or shortness of breath.