Pre eclampsia early pregnancy
Preeclampsia - Symptoms and causes
Overview
Preeclampsia is a complication of pregnancy. With preeclampsia, you might have high blood pressure, high levels of protein in urine that indicate kidney damage (proteinuria), or other signs of organ damage. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range.
Left untreated, preeclampsia can lead to serious — even fatal — complications for both the mother and baby.
Early delivery of the baby is often recommended. The timing of delivery depends on how severe the preeclampsia is and how many weeks pregnant you are. Before delivery, preeclampsia treatment includes careful monitoring and medications to lower blood pressure and manage complications.
Preeclampsia may develop after delivery of a baby, a condition known as postpartum preeclampsia.
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Symptoms
The defining feature of preeclampsia is high blood pressure, proteinuria, or other signs of damage to the kidneys or other organs. You may have no noticeable symptoms. The first signs of preeclampsia are often detected during routine prenatal visits with a health care provider.
Along with high blood pressure, preeclampsia signs and symptoms may include:
- Excess protein in urine (proteinuria) or other signs of kidney problems
- Decreased levels of platelets in blood (thrombocytopenia)
- Increased liver enzymes that indicate liver problems
- Severe headaches
- Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
- Shortness of breath, caused by fluid in the lungs
- Pain in the upper belly, usually under the ribs on the right side
- Nausea or vomiting
Weight gain and swelling (edema) are typical during healthy pregnancies. However, sudden weight gain or a sudden appearance of edema — particularly in your face and hands — may be a sign of preeclampsia.
When to see a doctor
Make sure you attend your prenatal visits so that your health care provider can monitor your blood pressure.
Contact your provider immediately or go to an emergency room if you have severe headaches, blurred vision or other visual disturbances, severe belly pain, or severe shortness of breath.
Because headaches, nausea, and aches and pains are common pregnancy complaints, it's difficult to know when new symptoms are simply part of being pregnant and when they may indicate a serious problem — especially if it's your first pregnancy. If you're concerned about your symptoms, contact your doctor.
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Causes
The exact cause of preeclampsia likely involves several factors. Experts believe it begins in the placenta — the organ that nourishes the fetus throughout pregnancy. Early in a pregnancy, new blood vessels develop and evolve to supply oxygen and nutrients to the placenta.
In women with preeclampsia, these blood vessels don't seem to develop or work properly.
Problems with how well blood circulates in the placenta may lead to the irregular regulation of blood pressure in the mother.
Other high blood pressure disorders during pregnancy
Preeclampsia is one high blood pressure (hypertension) disorder that can occur during pregnancy. Other disorders can happen, too:
- Gestational hypertension is high blood pressure that begins after 20 weeks without problems in the kidneys or other organs. Some women with gestational hypertension may develop preeclampsia.
- Chronic hypertension is high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy. High blood pressure that continues more than three months after a pregnancy also is called chronic hypertension.
- Chronic hypertension with superimposed preeclampsia occurs in women diagnosed with chronic high blood pressure before pregnancy, who then develop worsening high blood pressure and protein in the urine or other health complications during pregnancy.
Risk factors
Conditions that are linked to a higher risk of preeclampsia include:
- Preeclampsia in a previous pregnancy
- Being pregnant with more than one baby
- Chronic high blood pressure (hypertension)
- Type 1 or type 2 diabetes before pregnancy
- Kidney disease
- Autoimmune disorders
- Use of in vitro fertilization
Conditions that are associated with a moderate risk of developing preeclampsia include:
- First pregnancy with current partner
- Obesity
- Family history of preeclampsia
- Maternal age of 35 or older
- Complications in a previous pregnancy
- More than 10 years since previous pregnancy
Other risk factors
Several studies have shown a greater risk of preeclampsia among Black women compared with other women. There's also some evidence of an increased risk among indigenous women in North America.
A growing body of evidence suggests that these differences in risk may not necessarily be based on biology. A greater risk may be related to inequities in access to prenatal care and health care in general, as well as social inequities and chronic stressors that affect health and well-being.
Lower income also is associated with a greater risk of preeclampsia likely because of access to health care and social factors affecting health.
For the purposes of making decisions about prevention strategies, a Black woman or a woman with a low income has a moderately increased risk of developing preeclampsia.
Complications
Complications of preeclampsia may include:
- Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, the baby may receive inadequate blood and oxygen and fewer nutrients. This can lead to slow growth known as fetal growth restriction.
- Preterm birth.
Preeclampsia may lead to an unplanned preterm birth — delivery before 37 weeks. Also, planned preterm birth is a primary treatment for preeclampsia. A baby born prematurely has increased risk of breathing and feeding difficulties, vision or hearing problems, developmental delays, and cerebral palsy. Treatments before preterm delivery may decrease some risks. - Placental abruption. Preeclampsia increases your risk of placental abruption. With this condition, the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both the mother and baby.
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HELLP syndrome. HELLP stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count.
This severe form of preeclampsia affects several organ systems. HELLP syndrome is life-threatening to the mother and baby, and it may cause lifelong health problems for the mother.Signs and symptoms include nausea and vomiting, headache, upper right belly pain, and a general feeling of illness or being unwell. Sometimes, it develops suddenly, even before high blood pressure is detected. It also may develop without any symptoms.
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Eclampsia. Eclampsia is the onset of seizures or coma with signs or symptoms of preeclampsia. It is very difficult to predict whether a patient with preeclampsia will develop eclampsia. Eclampsia can happen without any previously observed signs or symptoms of preeclampsia.
Signs and symptoms that may appear before seizures include severe headaches, vision problems, mental confusion or altered behaviors.
But, there are often no symptoms or warning signs. Eclampsia may occur before, during or after delivery. - Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes, and may cause a stroke or other brain injury. The amount of injury to other organs depends on how severe the preeclampsia is.
- Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you've had preeclampsia more than once or you've had a preterm delivery.
Prevention
Medication
The best clinical evidence for prevention of preeclampsia is the use of low-dose aspirin. Your primary care provider may recommend taking an 81-milligram aspirin tablet daily after 12 weeks of pregnancy if you have one high-risk factor for preeclampsia or more than one moderate-risk factor.
It's important that you talk with your provider before taking any medications, vitamins or supplements to make sure it's safe for you.
Lifestyle and healthy choices
Before you become pregnant, especially if you've had preeclampsia before, it's a good idea to be as healthy as you can be. Talk to your provider about managing any conditions that increase the risk of preeclampsia.
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Pre-eclampsia - Symptoms - NHS
Pre-eclampsia rarely happens before the 20th week of pregnancy.
Although less common, the condition can also develop for the first time in the first 4 weeks after birth.
Most people only experience mild symptoms, but it's important to manage the condition in case severe symptoms or complications develop.
Generally, the earlier pre-eclampsia develops, the more severe the condition will be.
Early signs and symptoms
Initially, pre-eclampsia causes:
- high blood pressure (hypertension)
- protein in urine (proteinuria)
You probably won't notice any symptoms of either of these, but your GP or midwife should pick them up during your routine antenatal appointments.
High blood pressure alone doesn't suggest pre-eclampsia.
But if protein in the urine is found at the same time as high blood pressure, it's a good indicator of the condition.
Read more about diagnosing pre-eclampsia.
Further symptoms
As pre-eclampsia progresses, it may cause:
- severe headaches
- vision problems, such as blurring or seeing flashing lights
- pain just below the ribs
- vomiting
- sudden swelling of the feet, ankles, face and hands
If you notice any symptoms of pre-eclampsia, get medical advice immediately by calling your GP surgery or NHS 111.
Without immediate treatment, pre-eclampsia may lead to a number of serious complications, including:
- convulsions (eclampsia)
- HELLP syndrome (a combined liver and blood clotting disorder)
- stroke
But these complications are rare.
Read more about the complications of pre-eclampsia.
Signs in the unborn baby
The main sign of pre-eclampsia in the unborn baby is slow growth. This is caused by poor blood supply through the placenta to the baby.
The growing baby receives less oxygen and fewer nutrients than it should, which can affect development. This is called intra-uterine or foetal growth restriction.
If your baby is growing more slowly than usual, this will normally be picked up during your antenatal appointments, when the midwife or doctor measures you.
Page last reviewed: 28 September 2021
Next review due: 28 September 2024
Preeclampsia and pregnancy | Ida-Tallinna Keskaigla
Preeclampsia and pregnancy
The purpose of this information leaflet is to provide the patient with information about the nature, occurrence, risk factors, symptoms and treatment of preeclampsia.
What is preeclampsia?
Pre-eclampsia is a disease that occurs during pregnancy and is characterized by high blood pressure and protein in the urine. Preeclampsia is one of the most common complications of pregnancy. Epilepsy-like seizures occur in severe preeclampsia and are life-threatening. nine0005
What symptoms may indicate the development of preeclampsia?
High blood pressure - blood pressure values are 140/90 mmHg. Art. or higher. If systolic (upper) or diastolic (lower) blood pressure rises by 30 mm Hg. Art. or more, then such an increase cannot be ignored.
Protein in urine - 300 mg in urine collected over 24 hours, or +1 value on a rapid test.
Swelling of the arms, legs or face , especially under the eyes or if the skin is pitted when pressed. Edema can occur in all pregnant women and is generally harmless, but rapidly developing edema should be taken into account.
Headache that does not improve after taking pain medication.
Visual disturbances - double vision or blurred vision, dots or flashes before the eyes, auras.
Nausea or pain in the upper abdomen - These symptoms are often mistaken for indigestion or gallbladder pain. Nausea in the second half of pregnancy is not normal.
Sudden weight gain - 2 kg or more per week.
As a rule, there is a mild course of the disease that occurs at the end of pregnancy and has a good prognosis. Sometimes, preeclampsia can worsen quickly and be dangerous to both mother and fetus. In such cases, rapid diagnosis and careful monitoring of the mother and child are of paramount importance. nine0005
Unfortunately, most women develop symptoms in the final stages of the disease. If you experience any of the above symptoms, you should contact your midwife, gynecologist or the Women's Clinic emergency department.
Is preeclampsia called toxemia of pregnancy?
Previously, pre-eclampsia was really called toxicosis, or toxemia, since it was believed that the cause of the disease was toxins, that is, poisons in the blood of a pregnant woman.
What is the difference between preeclampsia and gestational hypertension?
Pregnancy hypertension is an increase in blood pressure above normal after the 20th week of pregnancy. With hypertension of pregnant women, protein in the urine is not observed.
What is HELLP syndrome?
HELLP syndrome is one of the most severe forms of preeclampsia. HELLP syndrome is rare and sometimes develops before symptoms of preeclampsia appear. Sometimes the syndrome is difficult to diagnose, as the symptoms resemble gallbladder colic or a cold. nine0005
When does preeclampsia occur?
Preeclampsia usually occurs after the 20th week of pregnancy. As a rule, preeclampsia goes away after delivery, but complications can occur up to six weeks after delivery, during which careful monitoring of the condition is necessary.
If by the sixth week after birth, blood pressure does not return to normal, then you need to contact a cardiologist, who will begin treatment against hypertension.
What is the cause of preeclampsia? nine0004
The causes of the disease are still not clear, there are only unproven hypotheses.
How does the disease affect pregnant women and pregnancy?
Most preeclamptic pregnancies have a favorable outcome and a healthy baby is born. However, the disease is very serious and is one of the most common causes of death of the child and mother. Preeclampsia affects a woman's kidneys, liver, and other vital organs, and if left untreated, it can cause seizures (eclampsia), cerebral hemorrhage, multiple organ failure, and death. nine0005
How does the disease affect the fetus?
In preeclampsia, the fetus does not receive enough oxygen and nutrients to grow, and intrauterine growth retardation may occur. In addition, the placenta may separate from the uterine wall before the baby is born.
Since the only treatment for preeclampsia is childbirth, sometimes a pregnancy has to be terminated prematurely. Until the 34th week of pregnancy, the lungs of the fetus have not yet matured, and steroid hormones are injected intramuscularly into the pregnant woman to prepare his lungs. In addition to the immaturity of the lungs, the health of a premature baby is threatened by many other diseases. nine0005
Who is at risk of developing preeclampsia?
Preeclampsia occurs in approximately 8% of pregnant women, many of whom have no known risk factors.
What are the risk factors for preeclampsia?
Patient-related risk factors
- First pregnancy
- Pre-eclampsia during a previous pregnancy
- Age over 40 or under 18
- High blood pressure before pregnancy
- Diabetes before or during pregnancy
- Multiple pregnancy
- Overweight (BMI> 30)
- Systemic lupus erythematosus or other autoimmune disease
- Polycystic ovary syndrome
- Long interval between two pregnancies
Risk factors associated with the patient's family
- Pre-eclampsia in the mother's or father's family
- Parental high blood pressure or heart disease
- Diabetes mellitus
What is the prevention and treatment of pre-eclampsia
The first trimester screening, or Oscar test, in addition to the most common chromosomal disorders, also calculates the risk of pre-eclampsia.
In case of high risk, pregnant women are advised to take aspirin (acetylsalicylic acid) at a dose of 150 mg in the evenings until the 36th week of pregnancy. This helps reduce the chance of preeclampsia by the 34th week of pregnancy by up to 80%. nine0005
Childbirth is the only treatment for preeclampsia. Sometimes a child can be born naturally, but sometimes, if the disease is very acute, an emergency caesarean section is necessary. The best time to have a baby is after the 37th week of pregnancy. Bed rest, medications, and, if necessary, hospitalization can sometimes help bring the condition under control and prolong the pregnancy. Often, a doctor will refer a woman with preeclampsia to the hospital for observation, as the condition of the fetus and pregnant woman may suddenly worsen. nine0005
Does bed rest help?
Sometimes bed rest is enough to control mild preeclampsia. In this case, the patient often visits a doctor who measures blood pressure, does blood and urine tests, and monitors the course of the disease.
The condition of the fetus is also often examined using a cardiotocogram (CTG) and ultrasound.
Are drugs used to treat preeclampsia?
High blood pressure sometimes requires medication. The medications used have few side effects, the drugs prescribed do not have much effect on the fetus, but are very important in the treatment of maternal high blood pressure. nine0005
Seizures are a rare but very serious complication of preeclampsia. Magnesium sulfate is sometimes given intravenously to prevent seizures in a pregnant woman with preeclampsia both during and after childbirth. It is safe for the fetus, but the mother may experience side effects such as hot flashes, sweating, thirst, visual disturbances, mild confusion, muscle weakness, and shortness of breath. All these side effects disappear when the drug is discontinued.
Can preeclampsia recur? nine0004
Preeclampsia does not necessarily recur in the next pregnancy, but the main risk factor for preeclampsia is the presence of preeclampsia in a previous pregnancy(s).
Risk factors for relapse include the severity of the previous case and the woman's overall health during pregnancy. A woman who has previously had preeclampsia should consult a gynecologist during a new pregnancy or when planning a pregnancy.
ITK1013
The information material was approved by the Health Care Quality Committee of East-Tallinn Central Hospital on 11/30/2022 (Minutes No. 18-22).
articles from the specialists of the clinic "Mother and Child"
What is it?
Pre-eclampsia is a severe complication of pregnancy that occurs after the 20th week of gestation. The main symptoms are an increase in blood pressure in combination with proteinuria (the presence of protein in the urine). A manifestation of severe preeclampsia is visual impairment, the work of the central nervous system, thrombocytopenia, impaired renal function, fetal growth retardation syndrome. As a rule, this complication becomes an indication for emergency delivery, as it poses a real danger to the life of the mother and child.
According to statistics, 16% of maternal deaths during pregnancy are due to preeclampsia. At risk: women over 35 years of age, as well as those who suffer from chronic arterial hypertension, kidney disease, diabetes, obesity, have multiple pregnancies and have a family history of preeclampsia. nine0005
Diagnostics
The task of modern obstetrics is the timely detection of patients with preeclampsia, but not at the stage when critical complications of preeclampsia have arisen that require delivery, but before they appear, which allows saving the life of the mother and fetus. But there is also the other side of the coin - this is the existing overdiagnosis of preeclampsia, which entails unjustified unnecessary hospitalization of patients. The fact is that symptoms resembling preeclampsia, the so-called "masks of preeclampsia", may indicate other, less dangerous health problems. So, for example, an increase in pressure may turn out to be "white coat hypertension", fear of a visit to the doctor, and pain in the upper abdomen - a sign of poor-quality dinner.
The use of a preeclampsia test in this situation helps the patient avoid unnecessary therapy and additional studies. nine0005
New approach
For a long time, the causes of preeclampsia were unknown to science - most often they attributed everything to genetic factors in which the adaptation of the female body to pregnancy is disrupted. However, as a result of many years of research, scientists around the world have come to the conclusion that the fault is the incorrect formation of the placenta, when an imbalance of angiogenic and anti-angiogenic factors occurs. As a result of such a violation, the patient develops vascular dysfunction: they become very permeable and capable of vasoconstriction (contraction). Protein begins to be lost through the vessels in the kidneys, edema occurs in the tissues and blood pressure rises. On the basis of the research obtained, an innovative Elecsys sFLT / PLFG testing method was developed, with the help of which, according to a blood test, these “wrong” particles can be detected in the bloodstream already in the first trimester and measure the risk of developing preeclampsia as a percentage.
Pregnant women in whom the test showed a high risk are given prophylactic aspirin in the early stages (this reduces the risk of complications by 62%). Such women continue to track blood tests once a month or once a week, depending on the numbers received. Thus, the doctors who observe them keep preeclampsia under control before it manifests itself as symptoms. In the Perinatal Medical Center, over a year and a half of testing the device, 480 studies were carried out, which helped to identify and prevent preeclampsia. nine0005
Today, in the PMC, it is possible to diagnose preeclampsia earlier, which means that symptomatic therapy can be started in advance, which makes it possible to delay the delivery date.
EXPERT OPINION
MARIA BORISOVNA SHAMANOVA , head of the Center for the treatment of miscarriage of the Perinatal Medical Center
Maria Borisovna, how has your medical practice changed since the introduction of the Cobas e 411 device? nine0203
“Unfortunately, earlier we found out that the patient had preeclampsia when the clinical picture of the disease unfolded in full: high blood pressure did not respond to drug therapy, protein loss progressed, and critical symptoms appeared.
It was very difficult to help prolong the pregnancy in such a situation. Today it is possible to diagnose preeclampsia earlier, which means that symptomatic therapy can be started in advance, which allows you to postpone the delivery date, because every day of intrauterine stay of a child increases his chances of being born healthy and viable. nine0005
Do women who do not have risk factors for preeclampsia need to be tested for prophylaxis?
- I think that it is not necessary, because pregnancy is not a disease. The most important thing for an obstetrician is to carefully collect an anamnesis, not to miss important nuances from a woman's life that would put her at risk for preeclampsia.
Have there been cases in your practice when the test allowed you to adequately assess the situation despite the clinical picture? nine0203
- Somehow a patient came to the appointment with a period of 22 weeks with fetal growth retardation and absolutely normal pressure.
