Preeclampsia in pregnancy means high blood pressure during pregnancy. This condition usually starts in the third trimester, or the last three months of pregnancy. Sometimes it occurs earlier, but this is rare.
The reason why blood pressure can increase during pregnancy is unknown. This is most common in first pregnancies and less so in subsequent ones. High blood pressure during pregnancy is said to exist if blood pressure before pregnancy (at prenatal check-up) is higher than blood pressure during pregnancy.
Treatment of preeclampsia during pregnancy depends on a number of factors, such as pregnancy age, the severity of hypertension, and the baby's ability to tolerate increased blood pressure. Treatment is usually rest and more frequent blood pressure monitoring.
Other tests performed include:
- Blood test
- Monitoring of fetal heart rate
- Urine test (protein urine)
- Determination of amniotic fluid volume
- Baby's growth assessment if necessary.
The only way to cure preeclampsia during pregnancy is to give birth. After giving birth, this disorder can immediately heal, or persist for a few hours to a few weeks
Classification of Diagnosis
Gestational hypertension
- Blood pressure 140/90 mm Hg for the first time during pregnancy
- No proteinuria
- Blood pressure returns to normal <12 weeks postpartum
- Final diagnosis is made postpartum
- May show other signs of pre-eclampsia, such as epigastric pain
Pre-eclampsia
Minimum criteria:
- BP 140/90 mmHg after 20 weeks of gestation
- Proteinuria 300 mg/24 hours or 1+ on dipstick
Increased certainty of Pre-eclampsia
- BP 160/110 mmHg
- Proteinuria 2 grams/24 hours or 2+ on dipstick
- Serum creatinine > 1.2 mg/dL
- Platelets <100,000/mm3
- Microangiopathic hemolysis Persistent headache or cerebral disturbance or other vision changes
- Persistent epigastric pain
Triad (three classic clinical signs of PE)
1. Hypertension
- BP 140/90 or higher
- Systolic pressure increases by 30 mm Hg, diastolic pressure increases by 15 mm Hg
- Mean arterial pressure > 105 mm Hg measured separately for 6 hours
- Average mean arterial pressure calculation; MAP: (Diagnosis 2) + S divided by 3
- MAP: average arterial pressure
- D: diastolic pressure
- S: systolic pressure
2. Proteinuria
Concentration of protein > 0.3 g in 24 hours, protein in urine > 1 g/L (random clean-catch, taken twice with 6-hour interval)
3. Edema
Urine retention indicated by increased body weight, anasarca edema
Eclampsia
Seizures not caused by other factors in a woman with pre-eclampsia
Chronic hypertension with superimposed pre-eclampsia
- New onset of 300 mg/24 hours of proteinuria in a woman with hypertension but without proteinuria before 20 weeks of gestation
- Sudden increase in proteinuria or blood pressure or count of platelets <100,000/mm3 in a woman with hypertension and proteinuria before 20 weeks of gestation
Chronic hypertension
- BP 140/90 mmHg before pregnancy or diagnosed before 20 weeks of gestation
- Hypertension first diagnosed before 20 weeks of gestation and persists after 12 weeks postpartum
Pre-disposition
Women who are at risk include:
- Having a history of vascular disease
- Being genetically prone to hypertension during pregnancy
- Trophoblastic disease
- Multiple pregnancies
- Renal disease
- Diabetes Mellitus
- Age > 35 years
- Previous history of PE
According to Sibai (2003), there are several potential causes, such as:
- Abnormal trophoblast invasion
- Immunological factors
- Maternal maladaptation to changes in cardiovascular and inflammatory changes during pregnancy
- Nutritional risk factors
- Genetic factors.
Prevention
Dietary manipulation and pharmacological efforts (salt restriction, low-dose aspirin and antioxidant administration).
Management
The main objectives of management for every pregnancy with pre-eclampsia complications are:
- Termination of pregnancy with minimum trauma to the mother and baby
- Delivery of a baby that can later develop
- Complete recovery of maternal health.
Early prenatal detection:
- Traditionally, prenatal check-ups are scheduled every 4 weeks until 28 weeks of pregnancy, then every 2 weeks until 36 weeks of pregnancy.
- Increased prenatal visits during the last trimester allow us to detect pre-eclampsia early.
- What should be monitored during each ANC:
- Headache history, blurred vision
- Oedema in the face, hands, and body
- BP
- Body weight Reflexes
- Lab tests
Termination of pregnancy
- Delivery of the fetus is a cure for pre-eclampsia. If the fetus is suspected or known to be premature, delaying delivery in hopes of gaining additional weeks in utero will reduce the risk of death or serious morbidity in the neonate.
- For moderate or severe pre-eclampsia that does not improve after admission, delivery of the fetus is usually recommended for the well-being of both the mother and the fetus. Delivery should be induced with intravenous oxytocin. If induced delivery seems certain to fail or efforts to induce delivery fail, a cesarean section is indicated for more severe cases.
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