Eclampsia And Preeclampsia During Pregnancy
- Preeclampsia and eclampsia are both hypertensive disorders that can occur during pregnancy.
- Preeclampsia is a precursor to eclampsia.
- Symptoms of preeclampsia include high BP, kidney-related problems, disturbed vision, headaches, etc. Eclampsia denotes the onset of seizures in a woman with preeclampsia.
- These conditions hold significant complications for both the mother and the baby and need to be managed with the right lifestyle changes and medications.
- Sometimes, the best alternative is early delivery.
Being pregnant can be a wonderful time for you as a woman; however, it does come with many challenges. After all, you are living and breathing for two, yourself and your baby. Changes in habits, behavior, appearance and more are all a part and parcel of this unique journey. However, one must be careful about certain unusual changes during this time. Changes that can harm you and your baby. One such change is developing preeclampsia and eclampsia. If you're wondering what are the symptoms of eclampsia after delivery, preeclampsia after delivery treatment and causes of pre-eclampsia in pregnancy keep reading.
What are the hypertensive disorders during pregnancy?
Before understanding what eclampsia is, we need to have a look at the base phenomenon that can affect some women during pregnancy: hypertension.
1. Hypertension during pregnancy
Preeclampsia and eclampsia are both parts of the spectrum of hypertensive disorders that occur during pregnancy.
2. Gestational hypertension
Gestational hypertension: Gestational hypertension occurs when a woman who previously had no issues with hypertension, but develops high blood pressure when she's more than 20 weeks pregnant. Normally, her blood pressure returns to normal after delivery. Gestational hypertension usually does not hamper the mother or the fetus. However, severe gestational hypertension can cause problems like preterm birth or the baby's size being smaller than expected at birth. Some women with gestational may go on to develop preeclampsia.
3. Chronic hypertension
Chronic hypertension definition: Chronic hypertension is high blood pressure that either precedes pregnancy, is diagnosed within the first 20 weeks of pregnancy, or does not resolve by the 12-week postpartum checkup.
Preeclampsia definition: The definition of preeclampsia is similar to that of gestational hypertension, in that the woman previously has no issues related to hypertension, but goes on to have increased blood pressure at or greater than 140/90 mmHg, increased swelling, and protein in the urine. Preeclampsia can also lead to preterm birth (before 37 weeks of pregnancy). If it is serious enough, it can also lead to eclampsia.
Eclampsia is defined as the new onset of seizures in a woman with preeclampsia. Eclamptic seizures can occur 20 weeks after gestation, before, during, or after childbirth. Seizures before 20 weeks are rare but have been documented.
Facts about eclampsia
Let's have a look at some facts about the prevalence and impact of eclampsia.
- Worldwide, the incidence of preeclampsia ranges between 2% and 10% of pregnancies
- According to WHO, the incidence of preeclampsia is seven times higher in developing countries than in developed countries
- Globally, about 12% of mothers die only from preeclampsia
- The overall estimation of the incidence of hypertensive disorders during pregnancy is 4.6% for pre-eclampsia and 1.4% for eclampsia
What are the symptoms of eclampsia?
1. Symptoms of preeclampsia
Besides blood pressure greater than 140/90 mm of Hg, preeclampsia may or may not be accompanied by other symptoms. However, your doctor may be on the lookout for other symptoms too, including:
- Excess protein in your urine
- Signs of kidney problems
- Severe headaches
- Changes in vision or light sensitivity
- Pain in upper stomach
- Nausea or vomiting
- Decreased urine output
- Decreased platelet levels in your blood
- Impaired liver function
- Shortness of breath, due to fluid in your lungs
2. Additional symptoms of eclampsia
Eclampsia symptoms include:
- Severe agitation
Complications of preeclampsia and eclampsia
Wondering what is the most common complication of eclampsia and preeclampsia? Keep reading. Preeclampsia needs to be treated and addressed in time to prevent some serious complications.
1. Complications affecting the mother
- HELLP Syndrome
A serious complication of eclampsia can be damage to your liver and RBCs. This is called HELLP syndrome, which stands for:
H - Hemolysis, in which oxygen-carrying red blood cells break down
EL - Elevated Liver enzymes, showing damage to the liver
LP - Low Platelet count, meaning that the cells responsible for stopping bleeding are low
The solution to this intense problem is to deliver the baby as soon as possible. Once the mother receives the treatment, full recovery is very much possible.
High blood pressure can disturb the blood flow reaching the brain, interrupting its oxygen and nutrient supply. This disruption can result in a stroke, and in case this situation is prolonged, it can also cause death.
- Blood clotting disorders
Your blood clotting system can break down. This can either result in too much bleeding or blood clots that develop throughout the body because the proteins that control blood clotting become abnormally active.
2. Complications affecting the baby
- Babies may grow more slowly in the womb than normal
- The baby may need to be delivered before they're fully developed
- Early delivery may cause problems due to underdeveloped organs such as breathing difficulties(neonatal respiratory syndrome)
What can cause preeclampsia?
The exact cause of preeclampsia is not known. However, it is believed that it occurs due to some problem with the development of the placenta.
The placenta is the organ that develops during pregnancy and is the source of food, nutrients, and oxygen for the baby.
This is possible because of the rich supply of blood vessels that the placenta receives, and it links the mother's blood with the baby's.
Food and oxygen pass from the mother's blood to the baby's and the waste products pass from the baby to the mother through the placenta.
Naturally, the placenta requires a large and consistent supply of blood to support the needs of the growing baby.
In preeclampsia, this fails to happen and the placenta does not get enough blood. The reason behind this could be some developmental issues in the early stages of pregnancy.
Such an issue with the placenta can disrupt the blood supply from the mother to the baby. The damaged placenta then may send some signals or substances that affect the mother's blood vessels and increase blood pressure.
At the same time, this may also result in problems in the kidney and some proteins that are important for the mother can leak into her urine, resulting in something called proteinuria(protein in the urine).
What can cause problems with the placenta?
Shortly after conception(fertilization of the egg by the sperm), the fertilized egg travels to the uterus where it implants itself into the womb. This is where the magic happens, i.e. where the baby grows.
The egg forms certain root-like structures, called villi, that help in anchoring the egg to the womb.
These villi transform and grow into the placenta, thanks to the nutrients they are fed via the blood vessels in the womb.
During the initial stages of pregnancy, these blood vessels also change shape to become larger and wider.
If something goes wrong with this transformation and the blood vessels do not change shape, it is possible that the villi do not get enough nutrients and this can hamper the formation of the placenta.
Why this transformation does not happen is not clearly understood but it could be possibly due to genetics or family history, but this is not a hard-and-fast rule, and it could affect someone who has no history either.
What are the risk factors associated with preeclampsia?
As we've already discussed, the exact cause of preeclampsia is not well understood. However, certain risk factors could predispose you to develop preeclampsia. Let's have a look at those.
- Having a pre-existing medical condition
This includes diabetes, kidney disease, high blood pressure, lupus, or antiphospholipid syndrome.
- Having preeclampsia in a previous pregnancy.
If you have 2 or more of the following factors, your risk is higher:
- First pregnancy: If it's your first pregnancy, preeclampsia is more likely to happen during this pregnancy than during any subsequent pregnancies.
- A long gap between subsequent pregnancies: A longer gap between two pregnancies, i.e. at least 10 years since your last pregnancy
- Genetics: If you have a family history of the condition - for example, your mother or sister has had preeclampsia
- Late pregnancy: If you are over the age of 40 and pregnant
- Weight: If you were obese at the start of your pregnancy, or if you had a body mass index (BMI) of 35 or more
- Multiple births: If you're expecting twins or more, such as twins or triplets
- Gestational diabetes: Having gestational diabetes in the current or previous pregnancies.
These risk factors make it all the more important to take the necessary precautions and screening measures. Identifying the problems early on can help manage the conditions and protect the health of both the baby and the mother.
If you have been identified for any of the risk factors of preeclampsia, it is recommended that you take the following steps to reduce the risk of actually developing the condition:
- Weight loss if you are overweight/obese(before you gain pregnancy-related weight).
- Controlling your blood pressure and blood sugar
- Exercise regularly.
- Maintain healthy sleep hygiene.
- Eating healthy foods that are low in salt
- Avoid caffeine
Screening and diagnosis
Diagnosis of preeclampsia can be based on certain markers you might show beyond the 20th week of your pregnancy. This includes primarily high blood pressure and any one or more of the following: protein in the urine, low platelet count, impaired liver function, headaches or visual disturbances, kidney-related issues besides proteinuria, or fluid in the lungs.
Having protein in the urine is not a prerequisite for having preeclampsia, experts now believe. It is possible to have preeclampsia without having proteinuria, however, high blood pressure remains the key marker.
Blood pressure beyond 140/99 mm of Hg is abnormal during a pregnancy. However, a single reading is not sufficient to determine if you have preeclampsia. It could be an anomaly or a one-time occurrence. But this could prompt your doctor to observe your numbers more closely in the future. He/she may take another reading after 4 hours, and if the reading is still high, this could confirm their doubts about preeclampsia. Your physician may also request other screening tests to ascertain the results. Some of these tests are:
- Blood tests
These tests may include liver function tests, kidney function tests, and a platelet count.
- Urine analysis
You may be asked to collect your urine for 24 hours. This urine would then be used to determine the amount of protein present in your urine. High protein content may indicate proteinuria and chances of preeclampsia. A single urine sample may also be collected to determine the ratio of protein to creatinine in the urine.
- Fetal ultrasound
Fetal weight is also an indicator of preeclampsia as it results in the baby being smaller for its age. Thus, your doctor may recommend an ultrasound to monitor your baby's weight. Your doctor may estimate the fetal weight and the amount of amniotic fluid through the images produced by the ultrasound.
- Non-stress test or biophysical profile
A non-stress test is a simple method of examining how your baby's heart rate is affected during its movements.
A biophysical profile measures your baby's breathing, muscle tone, movement, and the volume of amniotic fluid in your uterus with an ultrasound.
Management of preeclampsia and eclampsia
Once diagnosed, you may be asked to visit the hospital and undergo a few routine assessments. This would include monitoring you and your baby.
- Regular blood pressure checks
- Regular urine samples to measure protein levels
- Various blood tests to check your kidney and liver health
- Ultrasound scans
- electronically monitoring the baby's heart rate to detect any stress or distress in the baby
Management of preeclampsia
As we have already mentioned, preeclampsia puts you at an increased risk of several issues like seizures, clotting disorders, stroke, etc. Hence, the most effective treatment would be delivery. However, this is not possible very early during the pregnancy, hence you may be given certain medications to control the condition.
- Medicines to lower blood pressure: These are called antihypertensives and are usually not prescribed if the blood pressure is within the 140/90 mm Hg range. Many antihypertensive medications are not safe to be taken during pregnancy, hence it is essential to discuss the same with your doctor. Some medicines that may be used are labetalol, nifedipine, or methyldopa.
- Medicines for HELLP syndrome: Certain medications called corticosteroids may be prescribed to improve the liver function to prolong the pregnancy. These medications can help improve your baby's lung function(an important aspect of his life outside the womb) in as little as 48 hours.
- Medicines to prevent seizures: In case of very serious preeclampsia, your doctor may prescribe something called an anticonvulsant to prevent seizures.
Management of eclampsia
In case you have seizures, i.e. eclampsia occurs, magnesium sulfate or other anticonvulsants may be used. Resuscitation, controlling the seizures, management of blood pressure, and delivery are the usual steps that might be taken.
We are sure your questions about symptoms of eclampsia after delivery, causes of pre-eclampsia in pregnancy, and preeclampsia after delivery treatment is clear by now. Preeclampsia and eclampsia are both scary situations to be in when you are pregnant. However, taking the necessary precautions beforehand, especially if you have any of the risk factors can improve your outlook. Keeping up with your doctor appointments and regular assessments as recommended can help you avoid any complications due to eclampsia.
After birth, it is possible that your high blood pressure may not go away immediately. It may also take some time for other preeclampsia symptoms to resolve. Getting proper medical care even after delivery is important. With all this in mind, you and your baby can have a perfectly normal pregnancy and life beyond birth.
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