10 pre-eclampsia facts

10 pre-eclampsia facts

In this article, we will describe 10 facts about pre-eclampsia.

Key Points

1. Pre-eclampsia is a complication of pregnancy characterised by high blood pressure, protein in the urine and organ dysfunction. It affects approximately 5% of pregnancies.
2. Pre-eclampsia can start any time after the 20th week of pregnancy or even within the first few days after delivery; and for up to 6 weeks after labour.
3. Untreated pre-eclampsia can lead to eclampsia, which can be serious.
4. Common signs of pre-eclampsia are high blood pressure (over 140/90 mmHg) swelling near your eyes and hands and protein in your urine. Nurses and doctors will check your urine for protein at each pregnancy visit.
5. There is no known cure. The best way to treat pre-eclampsia is to deliver your baby.

Definition

• Hypertension: Blood pressure ≥140/90 mmHg; or a rise in systolic blood pressure ≥30 mmHg or diastolic ≥15 mmHg from baseline.
• Excess protein in the urine (proteinuria; indicating kidney damage): Urinary protein ≥1+ on dipstick or urinary ACR > 8 mg/mmol.
• Organ dysfunction: Impaired renal or liver function, thrombocytopaenia, and/or visual/cerebral symptoms.

Preeclampsia can start any time after the 20th week of pregnancy or even within the first few days after delivery, and for up to 6 weeks after labour.

Note. BP is usually low in pregnancy (120/70 or less).

Types

• Mild pre-eclampsia: Blood pressure <160/110 mmHg without severe organ dysfunction.
• Severe pre-eclampsia: Blood pressure ≥160/110 mmHg or severe organ dysfunction.
• Early-onset pre-eclampsia: <34 weeks gestation.
• Late-onset pre-eclampsia: ≥34 weeks gestation.

Epidemiology

• Affects 5% of pregnancies.
• Leading cause of maternal and foetal morbidity/mortality.
• Higher incidence in primigravidas, multiple pregnancies, and pre-existing medical conditions.

Risk factors

• Primigravida = first pregnancy.
• Previous history of pre-eclampsia.
• Pre-existing medical conditions (hypertension, diabetes, renal disease).
• Multiple pregnancy.
• Family history.
• Age younger than 17 or older than 35 years.
• Obesity.
• History of antiphospholipid syndrome.

Causes

• Placental hypoperfusion.
• Endothelial dysfunction.
• Immunological.
• Genetic predisposition.
• Environmental and lifestyle factors.

Note. Probably a combination of the above.

Symptoms

• Usually, no symptoms.
• Ankle/facial swelling.
• Headaches.
• Visual disturbances (photophobia, blurred vision).
• Nausea/vomiting/abdominal pain.
• Shortness of breath
• Over-rapid weight gain. Weight gain of more than 2 kg a week can be an indicator of pre-eclampsia.

Diagnosis

• At routine antenatal check-ups.
• Symptom assessment.
• Blood pressure monitoring.
• Urinary ACR.

• Blood tests: U+E, liver function tests (LFTs), FBC.
• Urinary protein (proteinuria; a sign of kidney damage): Albumin-to-creatinine ratio (ACR) > 8 mg/mmol/L (should be <3 mg/mmol); or urinary PCR > 30 mg/mmol (<15 mg/mmol).
• Foetal monitoring: Ultrasound, cardiotocography.

• Chronic hypertension.
• Gestational hypertension.
• Chronic kidney disease (CKD)
• Thyroid disorders.
• Primary liver disease.

• Mild pre-eclampsia: Monitoring, rest, and antihypertensive medication
• Severe pre-eclampsia: Hospital admission, corticosteroids, and urgent delivery.
• Seizure prophylaxis: Magnesium sulphate.

• Severe headaches.
• Visual disturbances.
• Severe abdominal pain.
• Vaginal bleeding.
• Foetal concerns.

• Maternal: Stroke, eclampsia, acute kidney injury (AKI), low platelets, HELLP syndrome; fluid in the lungs (pulmonary oedema), epileptic fits.
• Foetal: Growth restriction, preterm birth, stillbirth.
• Long-term: Increased cardiovascular risk.

HELLP syndrome causes problems with the liver and blood clotting. HELLP stands for the three parts of the condition:

• ‘H’ for haemolysis, – anaemia due to red blood cells breaking down.
• ‘EL’ for elevated liver enzymes – a sign of liver damage.
• ‘LP’ for low platelet count. Platelets are blood cells that help blood to clot.

• Generally favourable with timely diagnosis and management.
• Pre-eclampsia typically goes away within days to weeks after delivery.
• Risk of recurrence in future pregnancies.

• Aspirin: Recommended for high-risk women.
• Calcium supplementation: Recommended for women with low calcium intake.
• Close monitoring: Regular antenatal check-ups.
• Healthy lifestyle: Balanced diet, regular exercise.

Summary

We have described 10 facts about pre-eclampsia. We hope it has been helpful.