G,37, had fertility issues for the past five years. She had a successful IVF pregnancy on her second attempt and was at her 30 weeks of pregnancy. Her antenatal course was uncomplicated until a week ago when she felt her hands and feet become swollen. She thought this was quite common in the last trimester. Her face was getting puffy too. At her recent antenatal checkup, she also complained of occasional headaches. Her urine was found to have a substantial amount of protein. Her weight gain of 1 kg within a week was excessive. Her blood pressure had shot up from the usual reading of 100/70mmHg to 145/95mmHg. G was suffering from pre-eclampsia.
Consequences of preeclampsia
Pre-eclampsia is a life-threatening complication of pregnancy and a leading cause of ill health and death of both the mother and her unborn child. Worldwide, an estimated 4 million women are diagnosed with preeclampsia (previously called toxemia) every year, causing the deaths of more than 70,000 women and 500,000 babies.
Pre-eclampsia is characterized by the mother having high blood pressure, high levels of protein in urine indicating kidney damage (proteinuria), and signs of damage to other organs such as liver, lung, heart, or brain when the condition deteriorates. The fetus may be born prematurely or may suffer from intrauterine growth restriction (small for dates) or may be delivered as stillborn. (Please refer to the article “High Blood Pressure in Pregnancy: Pre-eclampsia” in the website).
Mothers who have a history of preeclampsia may have their life expectancy reduced as they have increased risks of heart disease, stroke and diabetes. Babies from a pre-eclamptic pregnancy may also have increased risks of brain developmental delay and cardiovascular and metabolic disease later in life.
Early detection of pre-eclampsia
Early detection of pre-eclampsia is thus important in ensuring the well-being of both the mother and the developing fetus. Following strategies are helpful.
1. Identifying Risks Factors: While the exact cause of pre-eclampsia remains unclear, there are several risk factors associated with its development. Pregnant mothers should be educated and be aware of the risk factors. These include:
First pregnancy
Pre-eclampsia in a previous pregnancy
High blood pressure before pregnancy
Diabetes before pregnancy
History of kidney disease
History of autoimmune disorders
Obesity
Maternal age of 35 or older
IVF (In vitro fertilization)
2. Early regular antenatal care: Receiving proper antenatal care is essential in identifying and managing risk factors. Attending regular check-ups can help detect and manage the condition early.
3. Healthy lifestyle: Maintaining a healthy lifestyle by eating a balanced diet, exercising regularly, and avoiding excessive weight gain during pregnancy can reduce the risk of pre-eclampsia.
4. Aspirin therapy: Low-dose aspirin in pregnant women at high risk of pre-eclampsia may reduce the chances of its development.
Monitoring pre-eclampsia
Monitor blood pressure: Regularly measuring and monitoring of blood pressure during antenatal visits is crucial in identifying the symptoms of preeclampsia. A significant increase in blood pressure can be an early warning sign.
Monitor symptoms: It is important for pregnant women to be vigilant about symptoms such as severe headaches, blurred vision, abdominal pain, swelling in the hands and face, and rapid weight gain. These can be early warning signs of pre-eclampsia.
Urine testing: Routine urine tests can help detect the presence of protein, which is a common indicator of pre-eclampsia.
Blood tests: Blood tests can be used to assess liver and kidney function and detect abnormalities in blood platelet levels. Some chemicals released by the placenta into the blood have been used as biomarkers in predicting the development of pre-eclampsia.
Ultrasound: This is used to monitor the baby’s growth including measuring the amniotic fluid levels and the blood flow of the placenta and the foetus.
Antenatal cardiotocography: This nonstress test is a simple procedure that checks the baby's heart rate to detect early signs of fetal distress.
G was put on medications to control her hypertension immediately. Both the mother and foetus were monitored closely. She was induced at 38 weeks of pregnancy and delivered a healthy boy weighing 3 kg. normally.