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New in the management of pre-eclampsia
Each month, the ritual is repeated. The midwife or the gynecologist takes our blood pressure and gives us a urinalysis. This test is used to measure the protein level. These are normally present in the urine in small quantities, because they are filtered by the kidneys. Except that sometimes (rarely before 20 weeks of amenorrhea), it’s a thunderclap: the displayed blood pressure is too high. This is what happened to Anne: “ I discovered by chance at the end of my pregnancy that I had preeclampsia. I was followed by a midwife who worried about my high blood pressure. Four days later, as it was not going down, I was hospitalized for 24 hours for proteinuria. This examination revealed that the protein level increased. When it came to initiating the birth, I disagreed. I didn’t feel any signs and I didn’t feel sick. I asked to be explained to me the risks for me and for my baby, before accepting. Finally, my son was born naturally, on the scheduled day of the outbreak.. »
Pre-eclampsia affects between 2 to 5% of pregnant women
It is a syndrome which associates hypertension (above 14/9) with a high level of protein in the urine, and edema, often on the hands and face. It is a complication of the second part of pregnancy, due to a dysfunction of the placenta. More precisely, it is an abnormality of the placental vascularization. The latter ensures less well the exchange of oxygen and proteins, and it releases toxic substances in the mother’s body. The mother-to-be’s brain, liver or kidneys can be affected by these substances, with a risk of seizures, liver damage (risk of HELLP syndrome) or kidney failure. The risks are great for the baby too. Preeclampsia can cause intrauterine growth retardation (IUGR). If not taken care of, it can cause fetal death in utero. The only way to stop this phenomenon is to stop the pregnancy by giving birth to the mother.
Read also: Pregnant, monitor your blood pressure
The result of a fetal rejection mechanism
The mother’s body reacts to its presence by trying to evacuate it, as during a transplant rejection. Normally, during pregnancy, the organism of the future mother lowers its defense system to better tolerate foreign antigens (in this case those of the father, present in the fetus). In women with preeclampsia, this tolerance system is not lowered. Thus, studies carried out fifteen years ago focused on the prevalence of pre-eclampsia in two populations of women: those who used condoms with their partner before pregnancy, and those who did not. Result: the women in the group “with condoms” were more likely than the others to have preeclampsia, probably because their body had not been accustomed to the presence of their partner’s antigens, via contact with the sperm. .
Although we still do not know the reasons for this pathology, we have a better idea of its risk factors. Obesity is one of them, as well as ethnicity and high maternal age. It is also known that women affected by type 1 or 2 diabetes have a higher risk of developing preeclampsia. Some women are more sensitive to it than others, because of their genetic background. Thus, in some families, there are several cases, in mothers, sisters … or even in the mother of the future father!
Hospitalization in most cases
The disease, if it was not detected by the tests, does not show any warning signs. On the other hand, you should immediately see the emergency room if you notice any sign: severe headaches, ringing in the ears, black dots or flies dancing in front of your eyes, lightning or flickering. . Ditto if you start to swell your hands or face. Once you get to the maternity emergency room, your blood pressure will be taken back and you will be given a urine test again, this time over 24 hours. You will also have an ultrasound and a monitoring, to judge the good vitality of the fetus. If the results are reassuring, it will be necessary to have monitoring and repeat the analyzes until delivery.
In practice, two scenarios emerge. Either you will be hospitalized until birth, or, if your eclampsia is mild and you can benefit from hospitalization at home, a midwife or a nurse will come to monitor the progress of the disease, with regular analyzes. On the other hand, if the test results are not good and your blood pressure continues to rise, you will be put on antihypertensive medication, which is safe for your unborn baby.
Read also: What is the eclampsia crisis
Delay childbirth as much as possible
Depending on the baby’s stage of prematurity, caregivers will try to save time, so as not to give birth too early. In anticipation of a possible premature birth, you will be given corticosteroids to help the baby’s lungs ripen and prepare him for ectopic life. Depending on the term of the pregnancy, you will be referred to a type 2 or 3 maternity unit. Induction and delivery by natural means are possible, but, in practice, in the event of prematurity and especially if the baby is delayed. growth (IUGR), a cesarean section is usually offered. Within 24 to 48 hours of birth, your condition may worsen, with still very high blood pressure, which may require increased monitoring. This is called the “rebound effect” of preeclampsia. But in general, after 5 to 10 days after childbirth, antihypertensive drugs can be stopped. In principle, all symptoms stop with the end of the pregnancy. Only 10% of women who have had preeclampsia while pregnant will maintain high blood pressure throughout their life and will therefore have to remain on treatment.
High risk for subsequent pregnancies
For subsequent pregnancies, the risk of having preeclampsia again is high (around 20%). In the event of a history of severe pre-eclampsia, or responsible for a premature delivery, preventive treatment is available. The doctor will prescribe, at the very beginning of pregnancy, from the 8th or 10th week of amenorrhea, low doses of aspirin (Aspégic type for infants) to thin the blood.
The trail of vitamin deficiencies
Several studies are underway, notably under the aegis of the PremUp foundation, on the prevention of pre-eclampsia. One of them should be presented to the National College of French Gynecologists and Obstetricians (CNGOF) at the end of the year. “We followed 3 patients who had a vitamin D deficiency,” explains Prof. Benachi, who took part in the study. The results are evaluated to see if there may be a link between vitamin D deficiency early in pregnancy and an increased risk of preeclampsia. These studies are used to assess whether supplementation could reduce the risk of developing preeclampsia. Other studies are in progress, implicating deficiencies in vitamins C and E, without one having for the moment established a link between the two. Research is also focusing on early detection at the onset of pregnancy. Associated with a Doppler ultrasound of the uterine arteries, they would make it possible to identify certain biological markers of pre-eclampsia, even before the rise in blood pressure, which would allow earlier treatment.