High blood pressure during pregnancy, types of hypertensive disorders (gestational hypertension, preeclampsia, and eclampsia) pathophysiology of preeclampsia, risk factors, signs and symptoms, complication and treatments.
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Preeclampsia is a common pregnancy complication and one of several hypertensive disorders that can occur during pregnancy.
When a woman with no history of hypertension develops high blood pressure at or after 20 weeks of pregnancy, she is said to have gestational hypertension. When gestational hypertension is accompanied by signs of maternal organ damage and/or fetal distress, the disorder is termed preeclampsia. Most common signs include presence of proteins in urine and increased swelling.
If a woman with chronic hypertension also manifests symptoms of preeclampsia, the condition is known as chronic hypertension with superimposed preeclampsia.
When preeclampsia affects brain functions, causing seizures or coma, it becomes eclampsia.
Preeclampsia and eclampsia may also develop after the baby’s delivery. Postpartum preeclampsia or eclampsia can occur regardless of whether the mother had high blood pressure or preeclampsia during pregnancy. These conditions are rare but they develop rapidly and can be life-threatening if not treated quickly.
Preeclampsia is more common in first pregnancies. Other risk factors include chronic hypertension, obesity, other health conditions, multiple pregnancy, previous preeclampsia or other pregnancy complications, in vitro fertilization, family history and the mother’s age and race.
Apart from high blood pressure, symptoms may include any or all of the followings: proteins in urine, swelling in face and hands, headache, blurred vision, right upper quadrant abdominal pain, nausea or vomiting, decreased urine output, and shortness of breath.
The pathophysiology of preeclampsia is thought to begin with abnormal placental development. The placenta is the organ that connects the fetus, via the umbilical cord, to the uterine wall of the mother. This is where the exchange between maternal and fetal blood takes place. The placenta provides the fetus with oxygen and nutrients and takes away waste such as carbon dioxide. In preeclampsia, the blood vessels supplying the placenta do not develop properly, limiting blood flow to the fetus. As a stress response, the placenta releases a number of factors into the maternal circulation. These factors disrupt maternal endothelial function, causing widespread inflammation, and systemic disease.
Preeclampsia is mild in most cases, but a mild preeclampsia can progress to severe or even full eclampsia very quickly, posing significant risks to both the mother and baby. Complications include maternal organ damage or failure, including stroke, impaired fetal growth, placental abruption, preterm birth, and pregnancy loss or stillbirth.
Delivering the baby usually resolves preeclampsia and eclampsia, although symptoms may continue and can be serious in some cases. The goal of treatment is to manage the condition to get as close to the due date as possible. Bed rest is recommended to lower blood pressure. Hospitalization may be required so the patient can be closely monitored. Medications may be prescribed to treat hypertension and to prevent seizure. If delivery is necessary before 37 weeks, corticosteroids may be given to help the baby's lungs develop.
