Pre-Eclampsia in Pregnancy

Pre Eclampsia is the most common serious medical disorder of human pregnancy. It can affect both the mother and her unborn baby. It usually arises during the second half of pregnancy, and can even occur some days after delivery.

In the mother, it can cause several problems of which she may be unaware – such as high blood pressure (hypertension), leakage of protein into the urine (proteinuria), thinning of the blood (coagulopathy) and liver dysfunction. Occasionally, Pre Eclampsia can lead to convulsions (fits), a serious complication known as eclampsia. Also, when a pregnancy is complicated by PE, the baby may grow more slowly than normal in the womb or suffer a potentially harmful oxygen deficiency.
How Common Is Pre Eclampsia?

Pre Eclampsia can affect as many as 10% of pregnancies, which makes it one of the most common pregnancy complications. It occurs more often in first pregnancies. Occasionally, women who have suffered it once find that it recurs in one or more subsequent pregnancies, and rarely a woman who has not experienced it in earlier pregnancies may develop it in a subsequent pregnancy.
What Is The Cause Of Pre Eclampsia?

The precise cause of Pre Eclampsia is unknown. However, genetic factors are probably involved, given women whose mothers and/or sisters have suffered Pre Eclampsia are at increased risk of the disease themselves. There is good evidence that the placenta is centrally involved in the development of Pre Eclampsia.

During pregnancy, the placenta requires a large blood supply from the mother to sustain the growing baby. It seems that in Pre Eclampsia the placenta does not receive sufficient maternal blood for its requirements. When this occurs, damage to the mother’s blood vessels follows, the result of which is increasing blood pressure. Kidney function is also disturbed and blood proteins leak from the mother’s circulation through the kidney into the urine. As Pre Eclampsia worsens, other organs are affected, including the mother’s liver, lungs, brain, heart and blood clotting system. Dangerous complications such as eclampsia (convulsions), cerebral haemorrhage (stroke), pulmonary oedema (fluid in the lungs from heart failure), kidney failure, liver damage and thinning of the blood (disseminated intravascularcoagulation) can occur in serious cases. However, these complications are fortunately rare.
How can Pre Eclampsia be detected and what are the symptoms?

A combination of rising blood pressure and protein in the urine can suggest Pre Eclampsia may be developing. As yet, there is no precise diagnostic test for Pre Eclampsia. However, if a previously healthy pregnant woman develops high blood pressure and proteinuria in the latter half of her pregnancy, then the diagnosis is almost always Pre Eclampsia. Some swelling (oedema) is common in normal pregnancy, but excessive swelling which also involves the face can occur in Pre Eclampsia. In severe Pre Eclampsia, other symptoms can appear, including severe headaches, visual disturbances (such as flashing lights), vomiting and pain in the upper abdomen. While such symptoms may have other less dangerous causes, they should never be ignored during pregnancy.

The relative deficiency in the blood supply from the mother to the placenta limits the baby’s supply of nutrients and oxygen, which may lead to reduced growth of the baby (intrauterine growth restriction) and even oxygen deprivation. The timing of delivery in cases of Pre Eclampsia which arise early in the second half of pregnancy can be particularly difficult, because a very premature fetus may be severely affected by Pre Eclampsia, but on the other hand, cannot be certain of survival outside the womb either.

Once a woman with Pre Eclampsia has developed persistent hypertension and significant proteinuria, the disease is considered to be severe and hospitalisation is required for careful monitoring of maternal and fetal welfare, stabilisation of various complications of Pre Eclampsia and preparation for delivery. Even though some features of pre-eclampsia. can be temporarily improved by treatments, the disease itself is progressive (sometimes slowly, but sometimes rapidly) until delivery. Blood pressure lowering drugs may often be necessary to reduce the risks of complications such as heart failure and stroke. Anticonvulsant drugs such as magnesium may also be required to prevent or treat eclamptic fits. Because of the progressive nature of Pre Eclampsia, once admitted, women are not usually discharged until after delivery.
How Can I Best Prevent Pre Eclampsia?

The best way to minimise the harm that Pre Eclampsia may cause in a pregnancy is to regularly attend for antenatal check-ups, so that the chance of detecting Pre Eclampsia in its earliest stages is optimised. If a woman is at particular risk of Pre Eclampsia, then it would be wise for her to attend a specialist obstetrician or maternity hospital with skill and experience in the management of Pre Eclampsia and its complications. Such women especially should consult with their doctors early in pregnancy, or even before pregnancy, to plan their antenatal care. All women should ensure that their blood pressure is checked regularly during pregnancy and that their urine is examined for the presence of protein. While small amounts of protein in urine specimens may be normal during pregnancy, amounts greater than a “trace” should not be ignored and should lead to further investigations to determine the cause of the proteinuria. Besides Pre Eclampsia, attention may be drawn by this simple antenatal test to other pregnancy problems such as urinary tract infections.

Women should always report worrying signs or symptoms to their doctor during pregnancy. Often there may turn out to be no cause for alarm, but it is a simple matter to have a blood pressure measurement, a urine check, a blood test or other investigations/ examinations to be sure that Pre Eclampsia is not the cause of the symptoms or signs of concern. Unfortunately, Pre Eclampsia does not provide a woman with early warning symptoms or signs so never miss an antenatal appointment!!
Personal Stories of Pre Eclampsia
Christine’s Story

I spent the first 5 months of my pregnancy in and out of hospital due to Hyperemesis Gravidarum, an abnormal condition of pregnancy where I could not stop vomiting. At 20 weeks gestation instead of putting on weight, I had lost 12kgs. By the time I was 22 weeks I still required anti-nausea drugs 3 times every day. Despite still feeling nauseous every day the vomiting had stopped, allowing me to finally eat and more importantly keep food down.

An underlying kidney disease increased the risk of complications during my pregnancy, one of which was Pre Eclampsia. By around 26 weeks my blood pressure started to slowly creep up a little each visit. Some protein was evident in my urine so I started to have fortnightly visits with the obstetrician. At my 28-week appointment the Ob decided to order another ultrasound, he had concerns that the baby had stopped growing. The results stated that my baby was 1-2 weeks smaller than the dates would suggest, and that it was nothing to worry about!

By the following visit my blood pressure had become borderline and I was told to see my GP in the middle of the fortnight. At this stage I had a persistent headache, being a headachy and migraine person I didn’t think anything of it. The one thing that did concern me was that during a 24 hour urine test that I completed over the weekend, it seemed as though none of the fluid I was drinking was coming back out of me. Little did I know that this was being caused by the pre-eclampsia. Thankfully I had made an appointment to see my GP on the Monday afternoon. It was then discovered that my blood pressure was 160 over 110, I was told to go straight to the hospital.

When I arrived at the hospital they planned to control my blood pressure via medication and complete bed rest for as long as possible. As a precaution they gave me steroid injections to prepare the babies lungs for an early delivery. In anticipation of potential complications they transferred me to a major hospital, which was better equipped to handle pre-term infants.

The following day was spent nervously completing tests and awaiting results. Later that same evening my whole body started to shake uncontrollably, and while attached to a foetal heart monitor I watched my unborn babies heart rate drop repeatedly to dangerously low levels. At this point the decision was made to perform an emergency caesarean. As we had discovered everything about pregnancy and evidently birth was completely out of our control, we just had to accept the situation and hope for the best. So while being prepped on the operating table I was not at all surprised at the discovery that the epidural had not worked! A general anaesthetic was organised and at 8.47pm that evening our tiny little boy Kyle Reid, weighing 2 pound 3 ounces (1040gms) was delivered.

It was explained that the Pre-eclampsia symptoms would get worse before they got better. This meant that I remained in the labour room until stabilised on the 4th day. I remember that my vision was very blurry and I experienced temporary hearing loss. I still had the shakes and was apparently quite puffy due to all that fluid my body was saving for a rainy day! I do remember asking my Mum if it was all a bad dream, had I ever been pregnant, and more importantly did I really have a baby? The nurses refused to take me to see him, and said that he was too sick to come up to me. It really felt like my worst nightmare, every time I was lucid enough to remember, my heart broke again, the only contact with my tiny baby was through a Polaroid photograph. On the 3rd day the nurses relented, they felt that keeping me from my child was becoming detrimental to my health so I was finally wheeled up to see him!

Upon further investigation of my placenta, massive calcification was discovered, we were told that our baby would have been lucky to survive another 2 weeks in utero. It makes me shudder to think what may have happened if we hadn’t gone to the GP in between visits to the obstetrician. We really are lucky parents to have our beautiful son. Kyle remained in hospital for 8 weeks, experiencing ups and downs, he came home weighing a whopping 4 pound 5 ounces (2045gms). The ups and downs continued throughout the first year and I am glad to say he is now a healthy, happy 18 month old. My blood pressure remained a problem for about 4 months after the delivery, requiring medication to control it. My eyesight was also poor for a couple of months but thankfully like my blood pressure it all returned to normal after a short while.
Anne’s Story (may be upsetting for some readers).

After two miscarriages, I was thrilled to find I was pregnant and doing well. At 23 weeks, my feet had become so swollen with fluid that I found it difficult to wear shoes, but I thought this was quite normal in pregnancy. At 25 weeks, the swelling spread to my hands and face, I couldn’t open my eyes because of the fluid. The local GP said it was an allergy. Blood pressure was slightly raised; I had severe headaches, indigestion and heartburn. At 26 weeks, the obstetrician found my blood pressure and protein was extremely high.

I was told I would die if I wasn’t delivered within 24 hours. He took me immediately by taxi to the hospital for an emergency Caesarean section, but delivery was delayed by 24 hours as the risk of heart attack or stroke was so great. The next day, under general anaesthetic, my daughter Brooke was born, weighing (804gm) l lb 12.5oz. It was discovered that I had had an abruption and a huge blood clot had formed between the placenta and my baby daughter. Her chances of survival had dropped from 30 percent to 10 percent. Brooke struggled long and hard for life.

After delivery I lapsed into a coma, lasting six days. The massive amounts of fluid made my brain swell, causing vivid hallucinations, aggressive behaviour and fear for my life. I was blinded for a period of time, alternating with double vision. Even today, it’s hard to believe that I lost six days out of both our lives.

On day six I saw my beautiful daughter for the first time. She was so tiny and grey-looking. The ventilator tube took up most of her face. There was very little of her that I could touch, due to all the tubes and equipment attached to her. I didn’t feel like a mother. I couldn’t hold my baby.

Brooke had sustained severe brain damage as a result of Pre-eclampsia. I cried an ocean of tears.

My little miracle, Brooke, came home 93 days later. With her she brought much love and happiness. Her struggle for life ended thirteen months and eighteen days later. But she leaves us with much determination and inspiration.

This is the first time I have put pen to paper to publicly share my experience, in the hope that I can help other bereaved parents.

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