PREGNANCY-RELATED CONDITIONS
PREECLAMPSIA
Preeclampsia is the development of severe hypertension during pregnancy. It is a serious condition that can be life-threatening for both the mother and fetus, and requires close medical attention. The onset of preeclampsia is usually during the late second or third trimester. Treatment approaches may vary depending on whether the preeclampsia is early-onset or later-onset during a pregnancy. About 2% to 8% of all pregnancies worldwide are affected by preeclampsia. However, first-time mothers and mothers with preeclampsia during a previous pregnancy are at significantly higher risk of of suffering form preeclampsia. If left untreated, preeclampsia can develop into eclampsia (preeclampsia with seizures) or HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count), both of which can require induction of labor/termination of pregnancy.
Below you can find a list of the most common risk factors, symptoms, causes and treatments. This can help monitoring during pregnancy, early-detection and mapping treatment strategies. In addition, it is important to keep up with you prenatal doctor's visits and discuss any symptoms or concerns with your OB/GYN.
Risk Factors
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First-time pregnancy
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Advanced age (>35 years)
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Race (Black or Native American women)
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Previous hypertension (high blood pressure)
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Multi-gestational pregnancy (twins or triplets, etc.)
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Comorbidity with other chronic diseases (e.g. diabetes, autoimmune or coagulative disorders)
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Previous pregnancy with preeclampsia
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Higher BMI (body weight)
Causes
Preeclampsia is believed to be caused by
underdevelopment of placental blood vessels during early pregnancy.
Because the placenta is the structure where nutrients pass from the mother's into the fetus' blood, decreased number, size and capacity of placental blood vessels leads to an increase in maternal blood pressure to compensate for the insufficient blood flow (and therefore nutrient exchange) in the placenta. Due to the decreased
placental blood flow and fetal nutrient deficiency, preeclampsia can
cause decreased fetal development, size and birth weight.
Symptoms
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Vision problems
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Shortness of breath
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Seizures (eclampsia)
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Severe nausea and/or vomiting
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Lightheadedness and headaches
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Oliguria (decreased urine output)
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Placental abruption (heavy bleeding)
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Proteinuria (increased protein amounts in urine, often making urine appear foamy or frothy)
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High blood pressure (>140/90 on several occasions)
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Abdominal pain (upper right abdomen, where the liver is located)
Treatments
In less severe cases, and especially
in early-onset preeclampsia, treatment may be limited to strict bed rest and
blood pressure controlling medication. So long as blood pressure can be down regulated
with such conservative means, the pregnancy can be continued to allow the fetus to mature within the womb as long as possible. This contributes to fetal health and decreases
the risk of perinatal or neonatal problems and disabilities.
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In more severe cases, induction of labor or
cesarean section may be required. Ideally, this should be at a time where
fetal development is far enough progressed to allow for life outside the womb. To enhance fetal development, corticosteroids can be given, which induce fetal lung development to prepare the fetus for preterm delivery. Mothers who are at risk of developing eclampsia might also
need anti-seizure medication to prevent the development of seizures.