HOW AND WHY DO WOMEN SUFFER FROM PREECLAMPSIA

Preeclampsia, a serious complication of pregnancy, affects 2-8% of pregnancies each year worldwide. 15% of these pregnancies end up in premature birth. In the USA, it affects every 1 in 5 pregnancies and according to the Center for Disease Control (CDC) in the USA, it kills more than 50 mothers every year.

But what is preeclampsia? 

Simply put, preeclampsia is a complication of pregnancy related to blood pressure due to vascular dysfunction in the placenta. Experts define preeclampsia as ‘the presence of blood pressure of greater than or equal to 140/90 mmHg on two different occasions at least 4 hours apart, after 20th week of gestation, with proteinuria of greater than or equal to 0.3g in a 24-hour urine sample in a previously normotensive patient’.

Pathophysiological Factors behind Preeclampsia

Not known for certain but the following factors are currently considered to be the most important

• Abnormal placental implantation
• Immunological intolerance in mother
• Genetic, environmental, and nutritional factors

The majority of research focuses on abnormal placentation as the main cause of preeclampsia. Failure of remolding of placental spiral arteries results in continuous high resistance to blood flow through these arteries and a constant state of vasoconstriction in maternal circulation culminates into endothelial cell dysfunction. Maternal systemic endothelial cell dysfunction results in signs and symptoms of preeclampsia.

Risk Factors of Preeclampsia

Certain health conditions, ethnicities, or complications in previous pregnancies can increase the risk of preeclampsia by several folds.

 Common factors that affect a woman’s risk include:

• Chronic hypertension before pregnancy
• Chronic kidney disease
• Previous history of preeclampsia or gestational hypertension
• Age older than 40
• Multiparity
• Twin gestation
• High body mass index
• Diabetes
• African-American ethnicity
• Family history of preeclampsia
• In Vitro Fertilization or other non-conventional ways of conceiving  
• Autoimmune conditions like lupus

Signs and Symptoms of Preeclampsia

Preeclampsia occurs around the 20th week of gestation but its symptoms usually appear around the 34th week. In a few cases, the symptoms appear after birth. Or in some cases, the symptoms don’t appear at all. The common features of the disorder are:

• Swelling/edema of hands and feet
• Severe vomiting or nausea
• Severe headaches or dizziness
• Troubled breathing
• Vision problems like blurry vision, flashes or floaters, and sensitivity to light.
• Epigastric or right upper abdomen pain
• Abrupt weight gain over 1 to 2 days
• Severe body aches

All features are consequences of elevated blood pressure (>139/89 mmHg), fluid retention, and protein loss in urine.

Complications of Preeclampsia

Blood pressure elevated for a prolonged period in preeclampsia can progress to Eclampsia resulting in seizures and fits in the patient. Eclampsia is a severe complication of preeclampsia that warrants immediate termination of pregnancy at whatever age of gestation.

HELLP Syndrome is another rare but deadly complication of preeclampsia with thrombotic microangiopathy of the liver. This results in liver failure with hemolysis and uncontrolled bleeding.

Other complications include placental abruption, stroke, heart failure, fluid build-up in the chest, reversible blindness, and bleeding diathesis like post-partum hemorrhage. 

Preeclampsia does not only affect the mother but also the baby. It leads to unplanned preterm birth. Preeclampsia is the leading cause of premature births around the world. Babies born in such ways are at high risk of hearing and vision problems, learning disabilities, epilepsy, cerebral palsy, and ischemic encephalopathy.

Diagnosis of Preeclampsia

Often preeclampsia causes no symptoms until after delivery. In such cases, regular antenatal check-ups with Ob-Gyn, regular records of blood pressure, and detailed physical examination play important roles in diagnosing preeclampsia.

In cases of moderate to severe preeclampsia, full blood count and liver enzymes for HELLP syndrome, weekly urine analysis for any protein loss, and ultrasonography for placental abnormalities are crucial in timely diagnosis.

Conclusion

Preeclampsia is new-onset hypertension after the 20th week of gestation associated with proteinuria and multi-organ dysfunction. Researchers continue to find the exact cause but the precise etiology of preeclampsia remains unknown. This disorder affects both mother and baby and is one of the leading causes of mortality and morbidity related to pregnancy.