pre-eclampsia

pre-eclampsia by wellsoul.comPreeclampsia is a serious pregnancy disorder that, if left untreated, can lead to serious complications for the pregnant woman and the fetus (or fetuses). It usually occurs after the 20th week of pregnancy and may even exist 4-6 weeks after birth.

Preeclampsia defines hypertension during pregnancy (systolic blood pressure> 140mmHg and diastolic> 90mmHg), along with albuminuria (> 300mg in 24-hour urine collection or> 30mg / mmol in random urine sample or more than one cross-stitch) or without pathological edema. Hand and face edema is not considered pre-eclampsia criteria based on new data.

Preeclampsia is considered to be severe when combined with heavy proteinuria (5gr / day) or with the involvement of other organs (headache, visual disturbances, abdominal distension of the liver capsule, difficulty in breathing, decreased urine output) and pathological laboratories,, increased liver enzymes).

Severe preeclampsia may be followed by elapsing with facial and hand spasms until stiffness and cyanosis (tonic-clonic spasm).
Rationale

Preeclampsia accounts for 2% of live births. It is considered a placental disease, but we do not yet know its exact etiology.

Possible causes include:

1. Abnormal implantation of the placenta due to immunological causes or large size. Poor adaptation of the mother's immune system to the allogeneic embryo could be the main cause of surface placentation. An anatomical discrepancy between mother and fetus is probably the central cause of inadequate placentalisation.

2. Vascular endothelial damage.

3. Poor diet.
Risk factors

Risk factors for the onset of preeclampsia include:


 Pre-eclampsia history in a previous pregnancy or first-degree relative.
 Interest: It occurs more frequently in women of childbearing age.
Afro-American race.
 Age (usually> 35 years and <20 years).
 Obesity.
 Multiple pregnancy.
 Gestational diabetes mellitus.
 Underlying diseases (chronic kidney disease, chronic hypertension, systemic lupus erythematosus, rheumatoid arthritis, etc.).

Predicting preeclampsia

Many biochemical markers have been proposed for early detection of women at increased risk of developing preeclampsia.

Diagnosis based on risk factors can identify only 30% of pregnancies with preeclampsia.

A newer method of screening population screening is to record the following parameters:


  •  Measurement of the flow rate wave in the uterine arteries (PI) at 11 + 0 to 13 + 6 weeks gestation.

  •  Woman's individual history and family history (including nationality and BMI).

  •  Measurement of mean blood pressure (MPA).


4. Measurement of PAPP-A (pregnancy-associated plasma protein-A) and PLGF (placenta growth factor).

This can detect 90% of cases of preeclampsia that require termination of pregnancy (with normal childbirth or cesarean section) before 34 weeks, and 45% of cases of later preeclampsia (after 34 weeks). ).

Therefore, if preeclampsia is predicted to occur before 34 weeks, antihypertensive drugs or aspirin are administered and thus serious complications are avoided.
Diagnosis

Finding high blood pressure (> 140 / 90mmHg) in routine testing raises the suspicion of preeclampsia. A second measurement is needed after 4-6 hours - at rest - and a urine test, where protein detection confirms the diagnosis.

The following is required:


  •  General blood

  •  General urine

  •  Liver Function Test (SGOT - SGPT - ALP-γGT)

  •  Renal function control (urea - creatinine)

  •  Control of uric acid

  •  Electrolyte control

  •  Blood coagulation test

  •  24-hour urine collection for protein determination
  • Complications


Most women can give birth normally if preeclampsia is diagnosed early and monitored during pregnancy.

However, the more severe the symptoms and the earlier they appear in pregnancy, the greater the risks for the mother and the fetus. The serious condition of the pregnant woman may require termination of pregnancy with normal childbirth or cesarean section. Cesarean section can be an option in difficult cases or in early pregnancy.

Complications include:


  •  Reduce blood flow to the arteries that carry blood from the uterus to the placenta, resulting in the fetus receiving less blood, oxygen, and nutrients. This can lead to intrauterine fetal growth retardation (IUGR), preterm birth, low birth weight, or neonatal respiratory distress syndrome.
  •  Increased blood pressure (> 180mmHg), which can lead to cerebral hemorrhage.

  •  Placental detachment, which can threaten the life of the fetus and pregnant woman.

  •  Liver rupture due to enlargement of the liver capsule.

  •  HELLP syndrome, characterized by low platelets and elevated liver enzymes. 6. Eclampsia mentioned above.

Fetal monitoring
The fetus may be affected by hypoxia, which is found by:

    Determination of embryo shapes by the pregnant woman herself.
    Assessment of fetal development using ultrasound (and Doppler examination).
    Fetal heart rate recording using a non-stress relaxation test (NST). It is a simple, non-invasive method that shows how the fetus's heart responds when it moves into the womb. It is reassuring and confirms the health of the fetus when the heart rate increases by 15-20 beats per minute, at least twice within the 20 minutes of examination.
    Biophysical profile that combines the findings of the NST with ultrasound fetal parameters (movements, muscle tone, breathing, estimation of amniotic fluid volume).

Treatment

The treatment of preeclampsia in pregnancy depends on the stage of pregnancy. If pregnancy is close to the probable date of birth, provocation is appropriate. If the pregnant woman is suffering from preeclampsia and pregnancy is not advanced, the most appropriate treatment is:

    Rest (indicated in the left lateral position, where the weight of the uterus does not cause pressure on the lower vena cava, also known as "lower vena cava syndrome").
    Limit salt consumption.
    Liquid consumption.
    Hypertensive drugs, which will lower blood pressure until birth, as well as magnesium sulfate (MgSO4), a drug with sedative and hypotensive effect.
    Corticosteroids that will help the lungs mature especially in pregnancies <37 weeks.

However, there are also cases of severe preeclampsia where childbirth is recommended. At the end of the hysterectomy, birth control drugs are avoided, as the main side effect is hypertension.

Usually, preeclampsia is immediately cured by the delivery of the birth and the elimination of the placenta. In some cases, however, the course of the disease may worsen within the first 48 hours after birth. For this reason, women diagnosed with preeclampsia or hypertension need to be closely monitored for their blood pressure, fluid intake, and excretion.

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