PRECLAMPSIA can either be subtle, sudden and severeor preventable
“A young, happyexpectant motherwith twins at 25th week of pregnancy, suddenly began to experience severe headaches and bouts of dizziness this was accompanied by nausea and vomiting, concerned for her health, her husband rushed her to the hospital.
A battery of tests followed and the Doctor's confirmed a suspicion of preeclampsia ordered her on bed rest for the rest of her pregnancy and prescribed antihypertensives, with weekly check-ups to monitor the health of her and her babies.
Two weeks before her due date, the doctor made the decision to deliver the twins via C-section, for her safety and that of her babies. The twins were born healthy and only remained under observation in the hospital for a week and a half.
However, the mother’s condition continued to deteriorate. Her urine output decreased, the levels of protein in her urine increased, and while her BP returned to a close-to-normal range, her left kidney began to fail. Her doctor decided to remove her kidney and continued her regimen of drugs to ensure further damage did not occur. After a few weeks, she had made almost a full recovery, and went home to her twins.”
Thiscasesummarizes the effect Eclampsia can have on a young family.
Pregnancy though considered as a normal physiological occurrence in women, required to preserve and perpetuate humans is associated with health risks for both the mother and the unborn child.
Eclampsia is one such serious medical condition that affects women during pregnancy, it occurs late in pregnancy and can cause seizures, convulsions and fatality of both mother and child.
Statistics suggests Eclampsia is a cause of concern and being aware is very important.
Globally 14 % of maternal deaths are contributed to Eclampsia.
Almost one in 50 women suffering eclamptic seizures die and 23% will require ventilation.
Around 35% will have at least one major complication including pulmonary oedema, renal failure, disseminated intravascular coagulation, HELLP syndrome, acute respiratory distress syndrome, stroke, or cardiac arrest.
Stillbirth or neonatal death occurs in approximately one in 14 cases of eclampsia
The word Eclampsia is derived from Greek meaning “Sudden” and is usually compared to a lightning strike. However,in realityit is preceded by a condition called Pre-eclampsia (PE),which usually appears after 20 weeks.It is characterised by the below symptoms, being aware and reporting these signs to your doctor can be crucial to a healthy pregnancy.
High blood pressure (Hypertension)
Protein in your urine (Proteinuria)
Swelling (Oedema) (face, hands & feet)
Nausea or vomiting
Abdominal (stomach area) and Lower Back Pain
Weight gain (>2.5 Kgs/week)
Please know having symptoms does not necessarily mean you have PE but they are cause of concern and require immediate medical evaluation, its is also interesting to note that few women with PE don’t have any symptoms.
Worldwide 2 – 8 % of pregnant women are affected with PE. In India, no definite incidence figures are available, but estimated to be between 5 – 15% based on hospital-based studies, 1 in 3 of maternal deaths and 43 neonatal deaths/1000 live births have been attributed to PE and its complications.
There are multiple causes for Preeclampsia, it is mainly associatedwith the placenta (the organ nourishingyourfoetus),early in pregnancynew blood vessels develop to supply blood to the placenta, in preeclamptic womenthis development is impaired (due to abnormal reaction to hormones) making them narrower and limiting the amount of blood that can flow through them.
Preeclampsia develops only as a complication of pregnancy and the risk factors include:
History of preeclampsia. A personal or family history of preeclampsia significantly raises your risk of preeclampsia.
Chronic hypertension. If you already have chronic hypertension, you have a higher risk of developing preeclampsia.
First pregnancy. The risk of developing preeclampsia is highest during your first pregnancy.
Age. The risk of preeclampsia is higher for very young pregnant women as well as pregnant women older than 40.
Obesity. The risk of preeclampsia is higher if your BMI is higher.
Multiple pregnancy. Preeclampsia is more common in women who are carrying twins, triplets or other multiples
Interval between pregnancies. Having babies less than two years or more than 10 years apart leads to a higher risk of preeclampsia.
History of certain conditions. Having certain conditions before you become pregnant — such as chronic high blood pressure, migraines, type 1 or type 2 diabetes, kidney disease, a tendency to develop blood clots, or lupus — increases your risk of preeclampsia.
In vitro fertilization. Your risk of preeclampsia is increased if your baby was conceived with in vitro fertilization.
The clinical diagnosis of preeclampsia till recently was driven by the development of symptoms and association of risk factors. Now however extensive research and development in medicine has yielded several significant biomarkers to support your doctors in preventing and managing your pregnancy better.
Two landmarkstudies have revolutionized the we diagnose and manage PE.
The first is the “ASPRE” (Aspirin for Evidence-Based Preeclampsia Prevention) trial which hasproved both early screening and preventionof PE is possible with advanced prenatal screening and simple intervention.
The early detection is done using a combination of laboratory investigations on the mother’s blood namely – PAPP A (Pregnancy associated plasma protein A) and PlGF (Placental Growth factor) with ultrasound findings of UAPI (Uterine artery Pulsatility Index) and blood pressure readings at 11-13.6 weeks of pregnancy. This can help withdetection almost 85-90 % cases at a population level.
Clinical intervention with low-dose Aspirin (75- 150mg/day)prescribed at bedtime can prevent complications of preeclampsia in majority of the women (statistically significant reduction of 82% (PE <34 weeks) and 62% (PE <37 weeks) screened as high risk.
The second is “PROGNOSIS” ((Prediction of Short-Term Outcomein Pregnant Women with SuspectedPreeclampsiaStudy)which provided evidence that simple blood tests namely SFlt1 and PlGF ratio can:
Diagnose and predict adverse maternal or foetal outcomes associated with PE in women who have developed symptoms post 20 weeks
Help with making crucial pregnancy related decision of timing the delivery and ensure reduction in unnecessary hospitalizationby serial surveillance.
The Preeclampsia foundation, estimates PE effects 1 in 12 pregnant women and is associated with 76,000 maternal deaths and 500,000 infant deaths each year providing access to medical facilities and creating awareness by spreading the word can help reduce these figures, ensuring a healthy Mom, healthy child with a happy family.
By Dr. Sujay Prasad, Medical Director, Neuberg Diagnostics