Preeclampsia: Maternal and Fetal Complications

Dr. Thitinan Tansatit

Obstetrics and Gynecology, Maternal-Fetal Medicine

Preeclampsia

     Preeclampsia is a pregnancy complication usually occurring after 20 weeks of gestation, characterized by high blood pressure (over 140/90 mmHg) and protein in the urine.

Causes of Preeclampsia

The exact cause is unknown, but evidence suggests it may result from

• insufficient blood supply to the uterus and placenta: leading to placental dysfunction.
• Mothers over 35 are at higher risk.
• Obesity and pre-existing conditions: like high blood pressure, diabetes, or kidney disease, also increase risk, especially if accompanied by sudden swelling in the face, arms, and legs. Rapid weight gain (more than 1.5-2 kg/month normally) combined with high blood pressure, headaches, blurred vision, or upper abdominal pain can also be warning signs.

Symptoms of Preeclampsia

     Most patients are asymptomatic, with high blood pressure only detected during prenatal visits. Severe symptoms include headaches, blurred vision, upper abdominal pain, and swelling in the arms or legs.

Diagnosis involves

• Blood pressure measurement and urinalysis: to check for excess protein.
• Blood tests: to assess organ function (liver, kidneys) and check red blood cell and platelet counts for abnormalities.

Such findings may indicate severe complications like seizures, pulmonary edema, difficulty breathing, anuria, acute kidney failure, or hepatitis.

Risks of Preeclampsia

     Preeclampsia can lead to fetal growth restriction, fetal death, placental abruption, and pre- or postpartum hemorrhage. Pregnant women should consult an obstetrician for close monitoring and watch for symptoms like facial swelling, limb swelling, foamy urine, headaches, or blurred vision.

Diagnosing Preeclampsia

     If these symptoms appear, seek a diagnosis for preeclampsia risk. This includes checking for vascular resistance in the uterine arteries and specific blood tests like placental growth factor and PAPP-A to assess placental implantation. Low-dose aspirin may be considered to reduce the risk of preeclampsia and its complications.

Treating Preeclampsia

Treatment depends on gestational age.

• For full-term pregnancies, immediate induction or C-section is recommended. If not full-term, the doctor's discretion is used based on severity.
• In severe cases, medications can be given to accelerate fetal lung development before delivery. While awaiting delivery, close monitoring for complications is crucial, and magnesium sulfate is administered to prevent seizures.

Summary

     While mild cases might only involve elevated blood pressure and swelling, severe preeclampsia can cause seizures, cerebral ischemia leading to temporary blindness, antepartum hemorrhage, or placental abruption, potentially resulting in fetal death. Kidney and liver dysfunction can cause jaundice, and there's a risk of postpartum hemorrhage for the mother.

Individuals at risk for preeclampsia should undergo diagnostic screening to reduce the risk of the condition and its complications.

Last updated: August 25, 2021