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Tuesday, April 16, 2024

Pre-eclampsia; what is it?

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By Ramatoulie Jobe
4th year medical student

“She’s young and cannot have high blood; this nurse or doctor doesn’t know what he or she is saying”. “Why would she go for an operation? She is a woman; she’ll push the baby out like her mates when it’s 9 months”.  “I don’t want a premature baby. I want to push the baby out like every other woman when it’s time”.  These are words that make my heart bleed. We take risks without weighing the risks and benefits.  Most have the concept that hospitals only opt for C-sections to be done because of the money but, is it really true? I have no idea.

We have seen a lot of patients with elevated blood pressures during pregnancy and labour, though they have never been diagnosed with hypertension before. Is it normal or abnormal? Does it back our superstitious beliefs that her co-wife or her mother’s co-wife wants her and her baby dead?

We your writer would say it is abnormal and it is a disorder. If there is one thing you’ll get from this article just know it has nothing to do with superstition. It can either be as a result of pregnancy induce-hypertension or pre-eclampsia. In this article, pre-eclampsia is our main focus.

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What is pre-eclampsia?

Preeclampsia is a pregnancy complication characterized by high blood pressure and proteinuria (protein in urine) and signs of damage to another organ system, most often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal.

What causes pre-eclampsia?

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With the mention of high blood pressure some would begin to think it has to do with the diet, salt intake and the like but the exact cause of preeclampsia involves several factors. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in pregnancy, new blood vessels develop and evolve to efficiently send blood to the placenta.

In women with preeclampsia, these blood vessels don’t seem to develop or function properly. They’re narrower than normal blood vessels and react differently to hormonal signaling, which limits the amount of blood that can flow through them.

Causes of this abnormal development may include:

o          Insufficient blood flow to the uterus

o          Damage to the blood vessels

o          A problem with the immune system

What are the symptoms of pre-eclampsia?

Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, or it may have a sudden onset. Monitoring your blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least four hours apart — is abnormal.

Other signs and symptoms of preeclampsia may include:

o          Excess protein in your urine (proteinuria) or additional signs of kidney problems

o          Severe headaches

o          Changes in vision, including temporary loss of vision, blurred vision or light sensitivity

o          Upper abdominal pain, usually under your ribs on the right side

o          Nausea or vomiting

o          Decreased urine output

o          Decreased levels of platelets in your blood (thrombocytopenia)

o          Impaired liver function

o          Shortness of breath, caused by fluid in your lungs

Sudden weight gain and swelling (edema) — particularly in your face and hands — may occur with preeclampsia. But these also occur in many normal pregnancies, so they’re not considered reliable signs of preeclampsia.

Who is at risk?

Preeclampsia develops only as a complication of pregnancy. Risk factors include:

History of preeclampsia. A personal or family history of preeclampsia significantly raises your risk of preeclampsia. This is where the genes come to play.

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 35.

Obesity. The risk of preeclampsia is higher if you’re obese.  Please watch your weight.

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 increases your risk of preeclampsia.

What are the complications of pre-eclampsia?

The more severe your preeclampsia and the earlier it occurs in your pregnancy, the greater the risks for you and your baby. Preeclampsia may require induced labor and delivery.

Although it disappears upon delivery of the baby, there are few complications related with it.

Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn’t get enough blood, your baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction, low birth weight or preterm birth.

Preterm birth. If you have preeclampsia with severe features, you may need to be delivered early, to save the life of you and your baby. Prematurity can lead to breathing and other problems for your baby.

Placental abruption. Preeclampsia increases your risk of placental abruption, a condition in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both you and your baby.

Eclampsia. When preeclampsia isn’t controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. It is very difficult to predict which patients will have preeclampsia that is severe enough to result in eclampsia.

Often, there are no symptoms or warning signs to predict eclampsia. Because eclampsia can have serious consequences for both mom and baby, delivery becomes necessary, regardless of how far the pregnancy is.

Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on the severity of preeclampsia.

Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you’ve had preeclampsia more than once or you’ve had a preterm delivery. To minimize this risk, after delivery try to maintain your ideal weight, eat a variety of fruits and vegetables, exercise regularly, and don’t smoke

The only way to cure pre-eclampsia is to deliver the baby, so you’ll usually be monitored regularly until it’s possible for your baby to be delivered.

Labour may be started artificially (induced) or you may have a caesarean section.

You’ll be offered medicine to lower your blood pressure while you wait for your baby to be delivered.

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