Preventing preeclampsia in pregnancy

MOTUNRAYO JOEL - Nigeria

writes about preeclampsia, an ailment that affects pregnant women.

A pregnant woman

About five per cent of pregnant women experience preeclampsia after 20 weeks of gestation. It is a complication characterised by high blood pressure, edema (swelling) and protein in the urine.

Sufferers of this medical condition experience symptoms such as: blurred vision, headaches, and more than normal weight gain.

According to a consultant obstetrician/ gynaecologist, Department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Dr. Gboyega Fawole, prenatal care, which includes, blood pressure monitoring, is very vital to every expectant mother, even if she appears very healthy.

"Monitoring an expectant mother's blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. Blood pressure, that is 140/90 or higher, and documented on two occasions, is abnormal. Also, it's possible to have symptoms of preeclampsia before 20 weeks of gestation, but this occurs only in rare cases. Preeclampsia usually begins after 20 weeks of gestation in a woman whose blood pressure has been normal. But a slight rise in blood pressure may be a sign of preeclampsia.

"The ailment can range from mild to severe, and it can progress slowly or rapidly. During screening, your doctors will check for the condition at every prenatal visit by checking blood pressure and urine sample for protein. The more severe the condition and the earlier it appears, the greater the risks for the mother and her baby. Most expectant mothers, who suffer from preeclampsia, develop a mild version near their due date, and they and their babies are still healthy with proper care," he said.

However, pregnancy induced high blood pressure or gestational high blood pressure is not preeclampsia. Gynaecologists have confirmed that a pregnancy-induced high blood pressure occurs, first, after the 20th week in pregnancy and this type of high blood pressure cannot translate to preeclampsia if protein is absent in urine after a test. Also, it is not preeclampsia if, six weeks after childbirth, the mother's blood pressure returns to normal.

Fawole submitted that when preeclampsia is severe, it could affect some organs and cause life-threatening complications, which is why the expectant mother needs to deliver early if her condition is diagnosed as severe or getting worse.

Explaining further, he said, "Preeclampsia constricts the blood vessels, resulting in high blood pressure and a reduced blood flow that can affect organs in the body. These are the liver, kidneys, and brain but when less blood flows to the uterus, it can portend a challenge for the baby, which results in poor growth and too little amniotic fluid. In addition, the baby may suffer the effects of prematurity."

Rarely, preeclampsia can lead to seizures. This medical condition is referred to as eclampsia and it creates very serious consequences for both the mother and the baby.

Fawole said, "The seizures may be preceded by symptoms such as severe or persistent headache, vision changes (blurred vision, seeing spots, or sensitivity to light), or intense upper abdominal pain. Sometimes, the seizures occur without warning."

On what causes preeclampsia, an obstetrician/gynaecologist at the University of Nigeria Teaching hospital, Enugu, Dr. Cyril Dim, proffers no exact cause.

"Since what causes preeclampsia is not known, no effective tests predict when preeclampsia will occur, and no treatments prevent preeclampsia from occurring (or re-occurring). Some factors are known to increase as a woman's risk of developing preeclampsia. These include having a history of high blood pressure before pregnancy, preeclampsia in previous pregnancy(ies) and other medical problems. The severity of preeclampsia and how early it occurs during pregnancy, the greater the risks for the mother and her baby," he said.

Dim stated, "For mild preeclampsia that is not rapidly getting worse, the sufferer may only have to reduce her level of activities, monitor how she feels, and ensures frequent office visits and tests. For moderate or severe preeclampsia, or for one that is rapidly getting worse, there is the need to visit the hospital for expectant management. This typically includes bed rest, drug prescription, and close monitoring of the mother and baby. Severe preeclampsia or an eclamptic seizure is treated with magnesium sulfate. This medicine can stop and prevent a seizure. If the expectant mother is near her due date or suffers from severe preeclampsia, doctors might deliver her of the baby(ies) as soon as possible."

"Preeclampsia may require induced labour and delivery. Surgical delivery (Cesarean Section) isn't always advantageous unless other problems are present. These include baby in breech presentation, or if a speedy delivery is necessary. Preeclampsia has no cure except for delivery of the baby. The treatment which the patient receives depends on the severity (mild versus severe) of the associated symptoms and the stage of the pregnancy."

Another gynaecologist, Dr. Kingsley Ekwuazi, proffered that with either a moderate or severe preeclampsia, the risk of seizures (eclampsia) continues for the first 24 to 48 hours after childbirth.

"In very rare cases, seizures are reported later in the postpartum period. Unless the patient has chronic high blood pressure, the blood pressure is likely to return to normal a few days after delivery. In rare cases, it can take six weeks or more. Some women still have high blood pressure six weeks after childbirth yet return to normal levels over the long term. If a mother's blood pressure is still high after baby's delivery, she may be placed on blood pressure drugs and ensure regular checkups with her doctor.

"After having preeclampsia, there is the higher-than-average risk of heart disease, stroke, and kidney disease. This is because the same things that cause preeclampsia also cause heart and kidney disease. In pregnancy, to protect the mother and baby's health, she should be in constant touch with her doctor and get the checkups needed," he said.

Meanwhile, another gynaecologist, Dr. Shukrah Okesina, advised that if preeclampsia is suspected during a pregnancy, sufferers should not self-diagnose and or try a treatment at home.

"Get an obstetrician as soon as possible. The doctor may recommend that the patient or caregiver should take and record blood pressures at home and provide the patient with instructions if certain symptoms or blood pressure levels occur."

To prevent preeclampsia, the Chief Medical Director, Medical Art Centre, Prof. Oladapo Ashiru, in a recent report said, "A number of therapeutic initiatives (starting before 16 weeks of pregnancy) are available, and they include low-dose aspirin and calcium supplementation. However, there has not been very good consistencies in the beneficial effects of these therapies, pointing to other factors such as genetics, immunological factors, abnormal trophoblastic invasion and adaptation of spiral arteries that work synergistically in the causes of preeclampsia."