Pre-eclampsia and Eclampsia

Description

Blood pressure (BP) problems, hypertension (BP too high) and hypotension (BP too low), are one of the most common reasons women are admitted to the hospital antenatal ward. High-tension is a common finding in early and mid-pregnancy and is, by and large, nothing to worry about. There are various types of high blood pressure problems in pregnancy. These include:

1. Chronic hypertension . This type of hypertension was present even before the woman was pregnant.

2. Pregnancy-induced hypertension (PIH). This type of hypertension is similar to the chronic type, but it first displays when a woman is pregnant and resolves completely after delivery. A proportion of women with PIH will go on to develop pre-eclampsia; unfortunately we cannot predict who it will be. Also, women who have PIH are at greater risk of developing hypertension later in life.
However, studies have compared outcomes of pregnancies in women with chronic hypertension and PIH, and it seems that there is little risk to the baby.

3. Pre-eclampsia. Pre-eclampsia is a disease unique to pregnancy. Pre-eclampsia is more likely to happen in a second pregnancy if one has suffered it before. Mild pre-eclampsia at term is less likely to recur (5-10%) and when it does, it's usually mild again. After severe pre-eclampsia, recurrence rate is about 20-25% in subsequent pregnancies. After eclampsia, about 25-30% of subsequent pregnancies will be complicated by pre-eclampsia, but only 2% with eclampsia again. Chronic hypertension is more common after pre-eclampsia, affecting about 15% at 2 years. It is more likely after eclampsia or severe pre-eclampsia (especially if recurrent or occurring during the 2nd trimester), affecting 30-50% of women.
Pre-eclampsia and eclampsia are the most important causes of death during pregnancy in the UK, USA and Nordic countries. Five to 10% of women in their first time pregnancies develop pre-eclampsia. It isn't really known what causes the disease.

Certain factors may make development of pre-eclampsia more likely.

Signs and Symptoms

Pre-eclampsia is characterised, not only by high BP, but also proteinuria (protein in the urine) caused by 'leaky' kidneys. However, pre-eclampsia doesn't just affect the BP and kidneys, it affects almost every organ system of the body. In the milder forms it might just be the kidneys that are affected to any serious degree, hence proteinuria is the only other sign.
If pre-eclampsia is more severe, it can cause headaches, flashing lights before the eyes (photophobia), abdominal pain as well as making you feel very jittery.
If severe pre-eclampsia is not treated or if it develops very quickly, then a serious complication called eclampsia may occur. This is when a woman has a seizure (fit). Usually the BP is very high and if the baby is not yet born, it becomes distressed. There is a serious risk of stroke in the mother due to the excessively high BP. Fortunately, eclampsia is rare as pre-eclampsia is usually picked up and treated. Women with established pre-eclampsia have overall about a 1% chance of having an eclamptic seizure. In about half of the women who suffer eclampsia, it occurs after the baby is born, usually within 24 hours of delivery.
Another serious, albeit rare, complication is the HELLP syndrome .

Diagnosis and Treatment

In addition to high blood pressure, the other main screening test is to check the urine for signs of proteinuria.

Ultimately the only treatment is delivery of the baby. This may be fine if a woman is, say, 38 weeks gestation, but at 30 weeks, it becomes much more of a dilemma. In the later stages of pregnancy it is normal to induce labour, but early on if delivery is decided upon, caesarean section is more usual. It's an individual decision and must be tailored to the patient and her disease severity.

For mild to moderate pre-eclampsia when a woman is prior to term, admission to hospital is needed and assessment of the severity of the disease carried out. In addition to regular examinations, the following tests are commonly arranged in order to assess severity and progression of the pre-eclampsia:

• 4-6 hourly blood pressure checks - BP in pre-eclampsia can go up & down very quickly.
• 24 hour urine collection - to estimate total protein. Also checks on each specimen are done to see if its suddenly getting worse.
• Blood tests such as blood count, kidney & liver function tests.
• Ultrasound scan . To check on the growth of baby, the water level around the baby (liquor volume) and the baby's movements & breathing to see its still as active as usual.
• CTG 's. Monitoring of the baby's heart with belt straps and Doppler pick-up. Usually done once daily.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Women's Health Information, © Dr. D. Tucker: http://www.womens-health.co.uk/