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High Blood Pressure in Pregnancy: Pre-eclampsia

T, 26, a first-time-mum was taken aback when I told her that her blood pressure had shot up from around 110/70 mm Hg in the first trimester to 140/ 95 mm Hg in the second trimester. She did not have symptoms like nausea and dizziness. There was no swelling around her ankles but her urine sample contained a small amount of protein. T had developed an obstetrical complication in pregnancy called pre-eclampsia.

What is Pre-eclampsia (PE)?

Pre-eclampsia is a complication of pregnancy that causes the mother to have high blood pressure and protein in the urine. It affects between 5 to 10 in 100 pregnant women and is diagnosed in the second half of pregnancy, during labour or soon after birth.

What is the cause of PE?

The exact cause of pre-eclampsia is not fully understood. Research studies have suggested that PE begins in the placenta — the organ that nourishes the fetus throughout pregnancy.

Early in a pregnancy, the fertilised egg implants itself into the womb by producing root-like growths called villi. These villi are fed nutrients through blood vessels in the womb and eventually grow into the placenta.

In women with preeclampsia, these blood vessels do not appear to develop or work properly. This may lead to the irregular regulation of blood pressure in the mother.

It is still unclear why the blood vessels do not work well as they should. It is likely that genetic factors may play a role, as the condition often runs in families. But this only explains some cases of PE. Oftentimes, there is no contributing factor

What are the signs of PE?

Most cases are usually asymptomatic. High blood pressure (hypertension) and protein in the urine (proteinuria) are usually picked up at routine antenatal checkups.

Weight gain and swelling of legs are quite common in pregnancy. But PE may be suspected if there is a sudden weight gain or a sudden swelling particularly in the face and hands.

In severe cases (0.5 % of pregnancy), PE can lead to serious, sometimes life- threatening, complications affecting both the mother and the foetus.

The symptoms of severe PE include:

· Severe headaches

· Blurring of vision or other visual disturbances

· Severe abdominal pain

· Nausea and vomiting

· Shortness of breath, caused by fluid in the lungs

Also read the article in the website High blood pressure put baby’s life at risk

What are the complications of severe PE?

Complications in the mother include:

· Seizures or convulsions (eclamptic fits) before or just after the baby’s birth

· Liver or kidney failure

· Problems with blood clotting as the number of platelets in blood are reduced

· Placental abruption: Premature separation of placenta before birth

Complications in the foetus include:

  • Intrauterine growth restriction (IUGR):As the placenta is affected, the foetus receives inadequate blood and oxygen and fewer nutrients.

  • Foetal distress: Foetus may become asphyxiated before or during birth

  • Prematurity

  • Stillbirth

Can PE be predicted early?

As PE is a potentially serious problem, many methods have been tried to detect it early. These include the use of ultrasound measurement of the uterine blood flow and the measurement of blood levels of biomarkers from the placenta. They are still not widely accepted in clinical practice.

New research published this year in the journal Nature may show promise. Researchers showed that RNA molecules sequenced from a single blood sample could predict preeclampsia early in pregnancy, months before symptoms appear.

T was monitored closely. She was treated with antihypertensive medication and her blood pressure was well controlled. Her foetal growth was normal. Labour was induced at 38 weeks gestation and she delivered a healthy baby girl weighing 3 kg normally.

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