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Preeclampsia (gestosis, preeclampsia, pregnancy intoxication) is a group of disease symptoms occurring in women after the 20th week of pregnancy (also during childbirth or puerperium), which is characterized by elevated blood pressure (> 140/90 mm Hg), may be life-threatening mother and baby.
Preeclampsia is persistent high blood pressure that develops during pregnancy or the postpartum period. It is often associated with high levels of protein in the urine or the development of a reduced number of platelets, problems with the kidneys or liver, fluid in the lungs, or symptoms such as seizures and / or visual disturbances. Diagnosis is based on the increase in blood pressure of the future mother, usually after the 20th week of pregnancy.
Read: Normal blood pressure – norms, measuring pressure, hypertension. Normal pressure in pregnancy
Preeclampsia usually starts after 20 weeks of pregnancy, but it may start sooner. Most pre-eclampsia occurs at or near term (37 weeks gestation). Preeclampsia can also appear after delivery (postnatal pre-eclampsia) that usually occurs between the first few days and one week after the baby is born. In rare cases, it begins a few weeks after giving birth.
See: Determination of the level of antibodies against pathogens threatening pregnancy
The specific causes of pre-eclampsia are not well understood. During pregnancy, blood volume usually increases to support the fetus, and the mother’s body must adapt to the load of this extra fluid. In some women, the body does not respond normally to changes in pregnancy fluids, leading to the symptoms of pre-eclampsia.
The causes of these abnormal responses to pregnancy changes vary from woman to woman and may differ depending on the stage of pregnancy in which the disease develops. Research suggests that pre-eclampsia is related to a problem with the placenta, the link between the mother’s blood supply and the fetus. If the connection between the placenta and the uterine arteries is insufficient, the placenta is not getting enough blood.
The placenta responds by releasing various substances that affect the lining of blood vessels (vascular endothelium). A woman’s blood vessels contract abnormally through certain mechanisms, causing high blood pressure. These narrowed blood vessels also affect other organs, leading to other signs and symptoms of pre-eclampsia.
Researchers are investigating whether changes in genes involved in fluid balance, vascular endothelial function, or placental development influence the risk of developing or worsening pre-eclampsia. Additional genes of unknown function in pregnancy are also associated with the risk of pre-eclampsia.
Many other factors likely also interact with genetic factors and contribute to the risk of developing this complex disorder. These risk factors include twin or multiple pregnancies, age over 35 or under 20, and pre-existing medical conditions. Socioeconomic status and ethnicity are also associated with the risk of pre-eclampsia, and nutritional and other environmental factors are believed to influence the likelihood of developing the disorder.
The editorial board recommends: Identical twins, i.e. monozygotic pregnancy
Pre-eclampsia risk factors
Certain factors have been identified that may increase the likelihood of developing pre-eclampsia. The main risk factors are:
- pre-eclampsia in a previous pregnancy. There is about a 1 in 5 chance that you will develop pre-eclampsia again in later pregnancies.
- diabetes, kidney disease, migraines, high blood pressure.
Other risk factors include:
- first pregnancy. Preeclampsia is more likely in the first pregnancy than in subsequent pregnancies.
- at least 10 years have passed since your last pregnancy,
- women in your close family have had pre-eclampsia (mother, sister),
- young age or age after 40,
- obesity at the beginning of pregnancy (body mass index was 30 or higher).
The editorial board recommends: BMI calculator – calculating the correct body weight, norms, risk of diseases
Symptoms of pre-eclampsia
Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly or it may be onset suddenly. Blood pressure monitoring is an important part of prenatal care as the first sign of preeclampsia is usually an increase in blood pressure. Blood pressure greater than 140/90 millimeters of mercury (mm Hg) or greater – documented twice, at least four hours apart – is abnormal.
Symptoms of mild pre-eclampsia: high blood pressure, water retention and protein in the urine
Symptoms of severe pre-eclampsia: headache, blurred vision, intolerance to bright light, fatigue, nausea and vomiting, small amounts of urine, shortness of breath and bruising.
Other signs and symptoms of pre-eclampsia may include:
- excess protein in the urine (proteinuria) or additional signs of kidney problems
- severe headaches,
- vision changes, including temporary loss of vision
- pain in the upper abdomen, usually under the ribs on the right side
- reduced number of blood platelets (thrombocytopenia),
- impaired liver function,
- breathlessness due to fluid in the lungs.
Many factors influence a doctor’s decision about how to manage pre-eclampsia, including the gestational age and health of the baby, the general health and age of the mother, and careful evaluation of disease progression. This includes blood pressure monitoring and the evaluation of laboratory test results that indicate the functioning status of the mother’s kidneys, liver, or the ability of the blood to clot. Other tests, such as fetal ultrasound and CTG, monitor how well the baby is growing and whether his health and life are at risk.
The pregnant doctor will watch for signs of maternal instability, including very high blood pressure that does not respond to antihypertensive drugs, signs of kidney and / or liver failure, and a reduced number of red blood cells or platelets.
Anti-hypertensive drugs will be used if blood pressure rises to dangerously high levels of 160/110 or higher.
If your baby has stopped growing, is growing slowly, or has symptoms that indicate that your baby’s health and life is at risk, your doctor may decide to deliver your baby early. Even if the baby is premature, labor may be required if the disease cannot be stabilized for maternal protection or provision.
Preeclampsia affects children mainly by reducing the amount of blood that flows across the placenta. Since the placenta is the only food source for the fetus, it can cause poor growth in babies, a condition called intrauterine growth restriction.
pre-eclampsia is the leading cause of preterm labor.
Preeclampsia can cause reduced blood flow to the mother’s placenta, reducing the baby’s food supply. As a result, the baby may become malnourished and small for his gestational age.
The baby survives in the uterus, receiving nutrients and oxygen through the placenta. Preeclampsia damages the placenta and the baby’s body begins to restrict the blood supply to the extremities, kidneys and stomach, trying to maintain the necessary blood supply to the brain and heart. If the baby’s oxygen supply is depleted (after the placenta breaks off or dies), the baby’s body may produce too much lactic acid. If too much lactic acid builds up, the baby will develop a so-called “Acidosis”. Labor is essential at this point, even if the baby is premature.
If the baby is growing slowly or if the pre-eclampsia is life-threatening to the mother, doctors may decide to have a premature birth. If a woman is before 37 weeks of pregnancy, doctors usually give her steroids to speed up the development of the baby’s lungs and magnesium sulfate to prevent maternal eclampsia and reduce the risk of neurological complications in the baby.
The risks of preterm labor depend on what week of pregnancy your baby will be born in. Preeclampsia usually develops towards the end of pregnancy and in such cases the baby should have little or limited consequences of prematurity.
However, if the baby has to be born by 34 weeks of age, he or she may face more serious health problems. Worldwide, pre-eclampsia is responsible for up to 20% of the 13 million premature births each year.
A baby is considered premature if it is born before 37 weeks, but more serious problems arise when the baby is born before 32 weeks.
The effects of having a baby early can vary considerably. Some babies may only spend a day or two under close surveillance, while others may spend the first months of their life in a Neonatal Intensive Care Unit.
As a result of premature birth, some babies may have lifelong health consequences such as neurological disorders, cerebral palsy, epilepsy, blindness and deafness.
Having a premature baby can also put a lot of emotional and financial stress on your family.
Unfortunately, there is no sure way to prevent pre-eclampsia. Although research is limited, some studies have shown that calcium supplementation or a low dose of aspirin may help some women under certain circumstances. However, there is insufficient evidence to recommend these measures to all pregnant women.
Still, leading a healthy lifestyle can help reduce the risk of pre-eclampsia. Regular exercise and a diet high in vegetables and low in processed foods have been shown to reduce the incidence of the disease in some women. Exercise and a healthy diet can also help control obesity, chronic high blood pressure, and diabetes, which are known risk factors for pre-eclampsia.