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Preeclampsia and Pregnancy

Dr. Sunil Preeclampsia – Pregnancy complication:

 Background:  Preeclampsia is a pregnancy complication characterized by high blood   pressure which usually begins after 20 weeks of pregnancy in a woman whose blood   pressure had been normal.

 Symptoms: Severe headaches, changes in vision, including temporary loss of vision, blurred vision or light sensitivity, upper abdominal pain, nausea or vomiting, decreased urine output, shortness of breath, sudden weight gain and pitting type ankle edema. But these symptoms also occur in normal pregnancies, so they’re not considered reliable signs of preeclampsia.

Diagnosis: Pre-eclampsia is diagnosed when a pregnant woman develops blood pressure ≥ 140 mm Hg systolic or ≥ 90 mm Hg diastolic on two separate occasions at least four to six hours apart after 20 weeks gestation with previous normal blood pressure and shows proteinuria ≥ 0.3 grams (300 mg) or more in a 24-hour urine sample or a SPOT urinary protein to creatinine ratio ≥ 0.3 or a urine dipstick reading of 1+ or greater.

Tests recommended:

– Liver function test for deranged serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels
– Kidney function test for oliguria, elevated creatinine levels
– Blood platelets counts for thrombocytopenia
– Urine analysis- 24 hours urine protein and creatinine

Ultrasonography:

– Transabdominal- For the assessment of status of the fetus and evaluation for fetal growth restriction
– Umbilical artery Doppler ultrasonography- For the assessment of blood flow.

Predictive tests: Preeclampsia may be diagnosed by predictive tests that include those related to placental perfusion, vascular resistance, kidney dysfunction, endothelial dysfunction, and oxidative stress.
– Doppler ultrasonography of the uterine arteries to investigate for signs of inadequate placental perfusion but this shows high negative predictive value in women with a history of preeclampsia.
– Elevations in serum uric acid (hyperuricemia) due to reduced uric acid clearance secondary to impaired kidney function.
– Angiogenic proteins such as vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) and anti-angiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt-1) show promise for potential clinical use in diagnosing preeclampsia.

Treatment: Only cure for preeclampsia is delivery. But if it’s too early in pregnancy, delivery may not be the best thing for the baby, then medications for lowering the blood pressure is preferred. Further, according to the conditions corticosteroids, anticonvulsant medications and bed rest might also be prescribed.

Preeclampsia is a progressive disorder and the signs of organ dysfunction indicate severe preeclampsia. A systolic blood pressure ≥160 or diastolic blood pressure ≥110 and/or proteinuria >5g in a 24-hour period also indicates of severe preeclampsia. Severe preeclampsia is a significant risk factor for intrauterine fetal death.

 Dr. Sunil Kumar , Ph.D ( Molecular Genetics), Maulana Azad Medical College, New Delhi, India.

June 9, 2015

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