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Pre-eclampsia is a condition that poses serious risks for you and your unborn baby
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Every pregnant mom knows the nerves and excitement that accompany an antenatal visit. But before you even get a chance to see your little one on the monitor, doctors need to check your blood pressure and the protein content of your urine. High blood pressure disorders are among the most common medical problems in pregnancy, occurring in between five to 10 percent of every 100 pregnancies. According to Cape Town-based gynaecologist, Dr Phillip Zinn, pre-eclampsia is diagnosed when the mother has both elevated blood pressure and protein in the urine. “It arises most commonly in the third trimester of pregnancy, but can also occur as early as 20th week of gestation.”
Cause
While the exact cause is unknown, Zinn says there’s evidence indicating that the placenta is somehow involved. “The scene is set for possible pre-eclampsia as early as 14 to 16 weeks into a pregnancy. This is when the placenta establishes greater control of its blood supply from the uterus by breaking down some of the muscle tissue in the blood vessels that supply the placenta. This breakdown of muscle tissue in the blood vessels is needed to optimise blood flow to the placenta through a low-pressure environment. For reasons thought to be immunological, this process does not take place efficiently and leads to a cascade of events later in the pregnancy that affect blood pressure and membrane interfaces throughout the mother’s body.”
Symptoms
Symptoms may include severe headaches and swelling that suddenly gets worse, especially if it includes the face. The symptoms of acute pre-eclampsia, which can come on very rapidly, include visual disturbances, lower or upper abdominal pain, persistent coughing, shortness of breath and blood in the urine. But Zinn warns that there are often no obvious symptoms until the condition becomes very severe, which can lead to an eclamptic fit.
The risk to mom and baby
Dr Ron White, a Johannesburg-based gynaecologist, explains that in severe cases virtually every organ of the body may be affected. “The major risk involves the brain resulting in convulsions, stroke and blindness. The kidneys are also affected. Renal failure is not uncommon and requires renal dialysis. The liver can haemorrhage causing liver failure. There is a very high risk of death in these cases.” White adds that the baby is at grave risk too. “The vessels of the placenta supplying blood to the baby go into spasm and the baby is starved of oxygen and nutrients, which limits its growth, and means the baby may die.” This is one of the main reasons for more frequent antenatal visits in the third trimester. The timely delivery of the baby can make the difference between life and death for both mother and child.
High-risk factors
While pre-eclampsia can occur in any pregnancy, there are pre-existing factors that place a pregnant woman at a higher risk, says White. These include a maternal age greater than 40 years; existing high blood pressure, or raised blood pressure occurring early in pregnancy; diabetes or pre-existing kidney disease; various heart diseases and having lost a baby in a previous pregnancy.
Zinn adds that the first pregnancy is far more likely to be affected than subsequent pregnancies. “However, a pregnancy with a new partner should be regarded as having the same risk as with your previous partner. Pre-eclampsia in the first pregnancy presents a risk for recurrence in a subsequent pregnancy.”
With the only cure for the condition being to end the pregnancy, doctors need to weigh up the options; the risk to mother and baby and the risk of ending the pregnancy with a premature baby, which may require ICU care. Zinn warns, “The clinician is often forced to deliver a very premature baby in order to save the mother’s life and give the baby a chance of survival.”
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