Pre-eclampsia

Pre-eclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys.

Definition and Diagnosis

Pre-eclampsia is defined as new-onset hypertension (blood pressure ≥140/90 mmHg) after 20 weeks of gestation, combined with evidence of end-organ dysfunction, such as proteinuria (protein in the urine), thrombocytopenia (low platelet count), renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual disturbances.

Cause and Risk Factors

The exact cause of pre-eclampsia is not fully understood, but it is thought to involve abnormal placental development, leading to the release of factors that cause blood vessels to constrict and become more sensitive to stress. Risk factors for pre-eclampsia include:

• First pregnancy
• Multiple gestations (twins, triplets, etc.)
• History of pre-eclampsia in a previous pregnancy
• Family history of pre-eclampsia
• Pre-existing medical conditions, such as hypertension, diabetes, or kidney disease
• Obesity
• Age ≥35 years

Symptoms

Symptoms of pre-eclampsia may include:

• High blood pressure
• Protein in the urine
• Severe headaches
• Vision changes, such as blurred vision or sensitivity to light
• Nausea and vomiting
• Abdominal pain
• Shortness of breath

Complications

If left untreated, pre-eclampsia can lead to serious complications for both the mother and the baby, including:

• Eclampsia (seizures)
• Stroke
• Kidney failure
• Liver rupture
• Pulmonary edema
• Placental abruption (premature separation of the placenta from the uterus)
• Preterm birth
• Low birth weight
• Fetal growth restriction

Treatment and Management

Treatment for pre-eclampsia depends on the severity of the condition and the gestational age of the baby. Options may include:

• Bed rest
• Medications to lower blood pressure
• Corticosteroids to promote fetal lung maturity
• Induction of labor or cesarean delivery if the condition is severe or the baby is at risk

Prevention

While there is no guaranteed way to prevent pre-eclampsia, certain measures may reduce the risk:

• Regular prenatal care and monitoring of blood pressure and urine protein levels
• A healthy diet and lifestyle
• Calcium supplementation (1.2-1.5 grams per day) for women at high risk
• Low-dose aspirin (81 mg per day) for women at high risk, starting between 12 and 28 weeks of gestation