Preeclampsia (mild, moderate or severe)

 

What is Preeclampsia?

Preeclampsia (toxemia, преэклампсия беременных) is a common complication of pregnancy that affects about 5 percent of pregnant women, it is characterized by hypertension, albuminuria (excretion of albumin in urine) and edema (swelling due to fluid retention). Preeclampsia usually occurs somewhere between late second trimester and first week postpartum.

Preeclampsia is common in primigravida women and in females with preexisting hypertension or cardiovascular disease.

The etiology of Preeclampsia is unknown. However, if left untreated, preeclampsia can suddenly progresses to eclampsia. Preeclampsia increases the risk of placental abruption, a life-threatening bleeding episode in which the placenta separates from the inner uterine wall before delivery. Other complications of preeclampsia include HELLP syndrome, a life-threatening liver disorder characterized by hemolysis, elevated liver enzymes and low platelet count. In a healthy person, platelet counts range from 150,000 to 400,000 per microliter

Symptoms

What are the symptoms of preeclampsia?

In addition to hypertension, preeclampsia symptoms can include:

1. Abdominal pain
2. Microalbuminuria or increased urinary albumin excretion rate
3. Albuminuria 1+ or the presence of albumin in the urine, in which the quantitative albumin excretion is more than 1 g/day
4. Proteinuria or the presence of protein in the urine, it occurs in 6-10% of all cases. Women with preeclampsia usually excrete 1000-3000 mg/day (1-3g/day) protein
5. Edema especially in the face, hands and feet
6. Visual disturbances and blurred vision
7. Rapid weight gain due to fluid retention
8. Dizziness
9. Reduced urine output (oliguria) or anuria
10. Reflex changes

Causes

What are the causes of preeclampsia?

Commonly Preeclampsia develops in women with preexisting hypertension or cardiovascular disease.

During labor, systolic blood pressure in a woman increases as much as 35 mm Hg, especially during the second and third trimesters of pregnancy. In pregnant women, gestational hypertension is defined as a blood pressure level of 140/90 mm Hg or higher. Without prompt treatment, increases in blood pressure in late pregnancy may progress rapidly to eclampsia and seizures

Gestational hypertension affects the kidneys, especially the glomeruli of the kidney where the the blood is filtered. Acute elevations in renal arterial pressure and flow can lead to an increased glomerular capillary pressure and glomerular filtration rate, which in turn can lead to proteinuria and albuminuria.

Treatment

What are the treatment options for preeclampsia?

Rest (bedtime regimen) and supportive therapy (liquids); however, the patient should be hospitalized and treated on an inpatient basis if symptoms do not resolve within 48 hours, supportive treatment should focus on stabilization and delivery in case preeclampsia had proven unresponsive to medicinal treatment

Management of severe preeclampsia

How to control hypertensive crisis during pregnancy?

The aim of the antihypertensive therapy is to decrease blood pressure by about 20-30 mm Hg

Fluid management in severe preeclampsia involves the administration of intravenous fluids or crystalloid infusions, such as normal saline or ringer’s lactate at a rate of 3 ml/minute (1 liter in 6-8 hours) before initiating vasodilator therapy and before administration of epidural anesthesia to prevent hypotension and fetal distress, as iv fluids cause a decrease in colloid oncotic pressure COP in pregnant females

Vasodilator therapy for preeclampsia involves using an oral calcium-channel blocker, such as Nifedipine to increase the cardiac index and lower blood pressure without reducing the blood circulation

Hydralazine 10 mg IV every 20 minutes to a max of 60 mg, maximum effects are seen within 20 minutes

Magnesium sulfate (MgSO4) 4g IV every 15 minutes until hyperreflexia resolves then 1-3g per hour IV to reach 4-7 mEq/L within 4-6 hrs. Monitoring serum magnesium levels and the patient’s clinical status is essential, as hypermagnesemia, can result in abnormal heart rhythms and asystole. In healthy individuals, serum magnesium levels are between 1.46–2.68 mg/dL

If the urinary output is less than 100 ml in 4 hrs the magnesium infusion should be stopped immediately

If urine output does not increase, to help you lower blood pressure, furosemide 10-20mg IV is prescribed to induce dieresis.

Next steps management

How to diagnose preeclampsia?

Patient Observation and constant attendance of the physician is essential to collect blood pressure, pulse, respiration rate, and reflexes. The data collected during the investigation must be recorded every 15 minutes. Continuous electronic fetal heart rate monitoring using a wireless fetal monitoring prototype technology is essential, the fetal heart rate should be determined every 15 minutes during your third trimester of pregnancy

Laboratory tests include CBC, BUN, creatinine, electrolytes, urine analysis, liver function tests, prothrombine time, urine dipstick testing for proteinuria and doppler ultrasound assessment of fetal growth, amniotic fluid volume and umbilical artery

How to prevent preeclampsia?

Lifestyle modifications, such as reducing sodium and sugar intake, drinking 6-8 glasses of water a day, going on a high protein diet and rest, lie-down on your left side to keep your body weight from placing pressure on major blood vessels

Women with mild preeclampsia should be monitored until at least 39 weeks to deliver

 

 

 

 

References

Verified by: Dr.Diab (November 30, 2017)

Citation: Dr.Diab. (November 30, 2017). What is Preeclampsia? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 6(2). urn:medcoi:article15696.