PRE-ECLAMPSIA: Why you should hate Hypertension during Pregnancy

PRE-ECLAMPSIA: Why you should hate Hypertension during Pregnancy {at least half as much as doctors do}!

This is a real life story

(Doctor’s mind talking). It had been a very busy morning shift in the emergency room in spite of being a rainy Saturday morning. A brisk glance at the wrist watch while signing out on another lab request form read 11.55am. Hmmm, I’ll be on this ER call all day till tomorrow morning, I had better snick out of here to catch a quick brunch before I become the next emergency here… (Sudden sound of confused conversation) Yeah right! I know what that means, here comes my next patient being stretchered in: morbidly obese woman looking lifeless at a first glance, additionally bulging tummy suggested that she is pregnant, dirty clothing and bruises on her face, hands and legs meant a fall; and thank God, so far no signs of bleeding PV (per varginum)- at least from where I was standing…

“Doctor Doctor please help I’m her sister, she woke up fine this morning o, nothing has been wrong with her… we finished washing clothes and she got up to go into the house when she suddenly fell down and started convulsing on the ground… Ah Doctor help me o, her husband travelled and I’m the only one with her… She has been fine o, she only complained of headache since the day before yesterday… She has been eating well, said she will register for Antenatal next week… please help us o (now crying)

Pregnant-Nigerian African Woman

What is PRE-ECLAMPSIA?

Pre-eclampsia is defined as a combination of a high blood pressure and excess protein in urine (proteinuria) after 20weeks of pregnancy and up to six weeks after delivery in a woman with a previously normal blood pressure, so it is a pregnancy specific disorder. Pre-eclampsia is said to complicate about 6-8% of pregnancies worldwide.

Sadly, the exact cause of pre-eclampsia is unknown though there are theories of several possible explanations; such as a possible reduction in the blood flow from the womb to the placenta due to a dysfunction of the blood vessels, or as an immune reaction from the mother’s system against the placenta, or just because of a genetic tendency.

WHO IS MORE LIKELY TO HAVE IT?  The good news is that studies and statistics from medical sciences at least knows enough about pre-eclampsia to specifically identify the most likely associations and risk factors for developing pre-eclampsia and they include:

1)      Previous incidence of Pre-eclampsia in past pregnancy

2)      First pregnancy or if the pregnancy is from a new father

3)      Seems to be commoner in women less than 20years or more than 35years

4)      Increases with multiple pregnancies (twins, triplets, etc)

5)      Record of similar history in female family members

6)      Presence of Diabetes Mellitus and/or Gestational diabetes, Obesity

7)      Presence of other illnesses like chronic hypertension, migraine headaches, kidney disease, and some other uncommon immune-related diseases.

8)      In rare tumours of the womb that mimics a abnormal forms of pregnancies like Hydatidiform mole

Diagnosis of Pre-eclampsia

  1. High blood pressure. In our environment, lots of women present late at clinics and so an absolute blood pressure value of 140/90mmHg is used. Ideally, the blood pressure value should be relative to the woman’s initial recorded blood pressure. A 25-30mmHg increase in systolic blood pressure and a 15mmHg rise in diastolic blood pressure are considered indicative of pre-eclampsia.
  2. Proteinuria (protein in urine) of up to 2+ in a urinalysis test or an absolute urine protein value of ≥ 300mg in a 24hour urine specimen.

***The absolute blood pressure value used for severe pre-eclampsia is 160/110mmHg.

What are the Symptoms of Pre-Eclampsia

Now here is where it gets tricky because symptoms of pre-eclampsia can range from mild to severe. In fact, affected patients usually do not show any suggestive symptoms (asymptomatic) at the onset of the illness –pretty much like hypertension doesn’t either, which is part of the reasons doctors hate pre-eclampsia. Well, here are some good reasons for you to join us in the hate. Its typical symptoms are:

  1. Severe headaches
  2. Nausea and Vomiting
  3. Dizziness
  4. Changes in vision e.g. blurred vision, temporary visual loss or light sensitivity
  5. A reduction in urine output
  6. Right sided abdominal pain
  7. Sudden significant weight gain (about 4kg weight gain in a week) with associated swelling of the feet and fingers.

* NOTE: Some swelling of the fingers and feet are normal in pregnancy so the presence of this symptom alone should not cause a pregnant woman to worry.

Pre-eclampsia posses a greater risk to both mother and baby when:

–          It starts earlier in the pregnancy

–          It continues tilting towards severe pre-eclampsia

It is important for a pregnant woman to see her doctor at the onset of any of these symptoms for proper evaluation and treatment. This is important because pre-eclampsia not caught and properly managed early enough can progress to its various complications which are life threatening to both mother and child.

Continued next week on Treatment …

 

 

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  • Marshall UKPOMA
    December 19, 2012 at 8:45 am #

    Eclampsia is pretty a life threatning pregnancy complication and its mode of presentation may be seen as a “spiritual attack”(in a “religious” nation like Nigeria) by people who do not know about it! families should learn more about pre-eclampsia and it’s underlying signs/symptoms so that they can get early medical care before seizure starts – your knowledge would help your health providers to help you better! Thank you Dr Mfon; I would love to get your contact; hopefully you can help on our team as we share more awareness on Preeclampsia and Eclampsia.

    • Dr. Mfon Okon
      December 20, 2012 at 5:41 pm #

      Thank you Marshall for your post. You can reach me via this email address here

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