Preeclampsia

Preeclampsia refers to a complication of the third trimester of pregnancy characterized by hypertension, proteinuria (increased levels of protein in the urine) and edema (swelling).

Eclampsia is defined as the occurrence of seizures in association with preeclampsia, which may be a serious condition.

Preeclampsia causes the decrease in the blood supply to the growing fetus and it is a risk to the health of the mother and the fetus.

Although the exact triggering cause of preeclampsia is not known, it is thought to occur when there is a problem with the placenta.

This complication occurs in 5% to 6% of pregnancies, particularly with first pregnancies in women older than 35 years and in women with pre-existing hypertension.

Preeclampsia usually occurs after 20 weeks gestation. The occurrence of preeclampsia before the 20th week of gestation is rare and it is usually associated with hydatidiform molar pregnancy.

In about 15-25% of cases of preeclampsia, seizures may occur and lead to eclampsia.

The main three physical signs of preeclampsia include:

• Hypertension or high blood pressure: Systolic blood pressure > 140 mm Hg or diastolic blood pressure > 90 mm Hg
• Proteinuria: High amount of protein in the urine with more than 300 mg per 24 hours or protein/creatinine ratio ≥ 0.3
• Edema: Swelling in the face, around the eyes, or in the hands

In addition, it is common to observe an increase in the uric acid level (hyperuricemia).

In some cases, it may be associated with clotting disorders and liver problems (HELLP syndrome).

In eclampsia, seizures can cause a stroke that may lead to death resulting from cerebral hemorrhage.

The treatment is focused on preserving the health of the mother and the fetus. It may include:

• Bed rest
• Blood pressure monitoring
• Medication
  • Antihypertensive drugs: Labetalol, nifedipine, or methyldopa are the preferred choice
  • For preventing seizure in case of eclampsia, magnesium sulfate is the recommended drug
  • In case of pulmonary edema, furosemide

Severe preeclampsia may require hospitalization awaiting for the optimal time to delivery.

For women with preeclampsia, early delivery may be needed in some cases.

The usual management is the following:

• Mild preeclampsia:
  • If pregnancy is at least 37 weeks or more, delivery is the safest option for the mother and the baby.
  • If pregnancy is less than 37 weeks, delaying delivery Is recommended when the condition is stable.
• Severe preeclampsia:
  • If pregnancy is at least 32 weeks or more, the recommend management is immediate delivery.
  • If pregnancy is less than 32 weeks and the status is not critical, delaying delivery may help to improve fetal lung maturity and prevent respiratory distress or necrotizing enterocolitis in the newborn.