Pre-eclampsia- Treatment, Childbirth options and Complications

High Blood Pressure- Hypertension

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Introduction to Pre-eclampsia

How is Pre-eclampsia Treated?

The treatment for pre-eclampsia is dependent on its severity and the gestational age of the foetus at the time of onset.

Note: The definitive treatment of the illness is ultimately the delivery of the baby.

Pre-eclampsia hypertension in pregnancy

If pre-eclampsia occurs towards the terminal end of pregnancy say around 37weeks, the treatment would be geared to stabilizing the mother’s blood pressure and delivery of the baby.

In earlier third trimester cases where the foetus is still immature, the mother has to be assessed properly to determine the severity of the illness. Mild forms of the illness may be managed on outpatient basis but the moderate-severe forms would require hospitalization for bed rest, use of antihypertensive medication and close foetal monitoring. This is called Conservative management and is aimed at stabilizing and maintaining the mother’s blood pressure while gaining time to achieve foetal maturity to increase the foetus’s chance of survival. Antihypertensive medications must be recommended by the doctor. Examples of the commonly used ones are Methyldopa and Nifedipine. Not all anti-hypertensive drugs can be used in pregnancy. However, where conservative management fails to keep the mother’s blood pressure stable, corticosteroids are usually given for foetal lung maturity and the foetus would have to be delivered as soon as possible. The mode of the delivery is best decided by the consulting obstetrician.

In much worse cases where there is severely high blood pressure, injectable Hydralazine is usually given slowly. At a diagnosis of severe pre-eclampsia, Magnesium Sulphate can be used to prevent the onset of seizures, and conversations should start on the best mode of quick delivery for the safety of both mother and child.

It is important to note here that since labour naturally elevates the blood pressure, the preferred mode of delivery is often via a Caesarean Section (CS).

Complications of Pre-eclampsia      

Failure to control pre-eclampsia can result in grave complications. If the above reasons haven’t convinced you enough to hate pre-eclampsia, these should help:

Complications for the Mother:

  • Eclampsia: This is an obstetric emergency because is it life threatening. Here, severe pre-eclampsia is complicated by the onset of seizures and/or coma. This specific new onset seizures is not due to any pre-existing or organic brain disorder. Its incidence seems to vary with development. In the UK its incidence is 1 per 2000 pregnancies but in Nigeria its put at about 11.8 per 1000 deliveries. It could occur during the pregnancy (40%), in labour (20%) or after delivery (40%). The treatment aim in managing this complication is aborting the current seizure and the prevention of another seizure, stabilising the mother’s condition and subsequent delivery of the baby immediately (ideally via CS except if she has already progressed in labour).
  • HELLP Syndrome: The HELLP acronym depicts the disorders all going wrong across different parts of the body almost at the same time, hence it is called a syndrome. It is a combination of Haemolysis (breakdown of red blood cells), Elevated Liver enzymes and Low platelets, and there can be associated disseminated intravascular coagulation. Bottom line is that it can easily result in subsequent maternal and foetal death.

Complications for the Baby:

  • Intrauterine growth retardation
  • Low birth weight
  • Respiratory distress
  • Preterm birth
  • Placental Abruption- this means the separation of the placenta from the attachment point on the inner wall of the uterus which results in heavy bleeding and is life threatening for both mother and child.

Obviously, coming up with a way to prevent its onset in the first place will be most valuable but unfortunately, there are no known specific preventive measures for developing the illness. But prompt registration and attendance to Antenatal clinics with regular blood pressure and urine tests can aid early detection of pre-eclampsia and ensure proper management is commenced on time.

 

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