From Diagnosis to Delivery: Navigating Pre-eclampsia in Pregnancy

Eclampsia is the last stage of pre-eclampsia that requires immediate medical attention. However, most cases are detected before it turns into eclampsia. There is actually no cure for pre-eclampsia, but doctors often treat the condition with BP and antispasmodic medications to avoid it.

The only cure for both pre-eclampsia and eclampsia is childbirth. Usually, a cesarean delivery is necessary to prevent blood pressure from rising during delivery.

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Symptoms of eclampsia can occur anytime during pregnancy. Very few symptoms are known in this. And it is difficult to detect the symptoms of eclampsia without a doctor.Some of the most common symptoms of pre-eclampsia are:

• Severe headache
• Gaining excessive weight during pregnancy. More than one kilo per week.
• Nausea, vomiting or stomach pain. 
• Swelling of hands, feet and face.

When preeclampsia progresses to eclampsia, it may also cause the following symptoms:

• Muscle pain
• Seizures.

There is no cure for pre-eclampsia other than childbirth. If it is diagnosed early, it can often be controlled by lowering blood pressure with medication and rest. Pre-eclampsia can also be prevented from progressing to eclampsia by using anti-seizure medications.There are a few conditions related to eclampsia that can occur either with or without symptoms:

• Edema: swelling of tissue caused by fluid buildup in the tissues. This usually occurs in the extremities
• Pulmonary edema: when the same fluid builds up in the lungs, causing difficulty breathing.
• Headache: This is probably caused by high blood pressure caused by eclampsia.
• Gestational diabetes: Symptoms of diabetes in pregnancy that can cause the fetus to gain weight.

Each case of eclampsia is different. People may experience any of these symptoms or may not have any.

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The exact causes of pre-eclampsia involve several factors. Experts believe it begins in the umbilical cord or placenta. The placenta provides nourishment to the fetus during pregnancy. In early pregnancy, new blood vessels develop and work effectively to carry blood to the placenta.

In women with pre-eclampsia, these blood vessels do not develop and function properly. They are thinner than normal blood vessels and respond differently to hormonal signaling. The process of hormonal signaling determines the amount of blood that flows through them.

This abnormal development may be due to:

• Inadequate blood flow to the uterus.
• Injury to blood vessels.
• Problems with the immune system.
• Certain genes.

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In the past, pre-eclampsia was diagnosed simply by looking for protein in the urine and measuring high blood pressure. However, experts now know that protein in the urine is not a common symptom of preeclampsia – that is, you may have preeclampsia but not have protein in your urine.

It is unusual to have a BP higher than 140/90 mmHg in pregnancy. However, a single high blood pressure reading does not necessarily mean you have pre-eclampsia. Your doctor will monitor if the reading shows an abnormal BP or is much higher than your normal blood pressure.

If a second test four hours later also shows an abnormal blood pressure, your doctor will confirm the suspicion of pre-eclampsia. Your doctor may ask you to have additional BP tests, blood or urine tests.

Other important tests -If your doctor suspects you have preeclampsia, he or she may ask you to have other tests such as:

• Blood Test

The doctor may ask you to have liver function tests, kidney function tests, and tests to check the number of platelets (cells that help blood clot) in your blood.

• Urine Analysis

The doctor will ask you to provide a urine sample so that he or she can check the amount of protein present in the urine.

• Fetal ultrasound

The doctor may also ask you to check your baby's growth through an ultrasound. The images of your baby during an ultrasound test help the doctor estimate the weight of the fetus and the amount of fluid in the uterus (amniotic fluid).

• Nonstress test or biophysical profile

A nonstress test is a simple procedure that measures the baby's heart rate when it moves. A biophysical profile uses ultrasound to measure the baby's breathing, muscle movements, and the amount of amniotic fluid in the uterus.

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The only treatment for pre-eclampsia is delivery. Until your blood pressure comes down, you are at increased risk of seizures, placental abruption, stroke, and possibly severe bleeding. If this is happening early in your pregnancy, delivery is not a good option. If you have preeclampsia, your doctor will tell you how often you need prenatal visits. You will also need to have frequent blood tests, ultrasounds and nonstress tests to check for pregnancy complications. The following are possible treatments for pre-eclampsia:

• Taking blood pressure-lowering medicines.
• Taking corticosteroids. Corticosteroids help your baby's lungs mature within 48 hours, which helps the baby come out of the womb early.
• Taking antispasmodic medicines.
• If preeclampsia is more severe, your doctor may suggest anticonvulsant medicines such as magnesium sulfate to prevent it.
• Women with pre-eclampsia are advised to rest, but studies have shown that it may not be beneficial, and may increase your risk of developing blood clots.
• Severe pre-eclampsia may require hospitalization. In the hospital, the baby and the amount of amniotic fluid are regularly checked with a nonstress test or a biophysical profile. A decrease in the amount of amniotic fluid indicates poor blood supply to the baby.
• If preeclampsia is diagnosed in the late stages of pregnancy, the doctor may recommend immediate delivery.
• In severe cases, the gestational age of your baby or the readiness of your cervix are not considered. If it is not possible to wait, the doctor may recommend induced labor or arrange for a C-section. During labor, you may be given magnesium sulfate intravenously to prevent seizures.
• If you need painkillers after delivery, ask your doctor about it. Taking any medicine without advice can increase your BP.

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Pre-eclampsia is a condition that develops as a complication of pregnancy. Its risk factors are as follows:

• The risk increases if you or someone in your family has previously suffered from pre-eclampsia.
• Chronic hypertension If you already suffer from hypertension, then your risk of developing preeclampsia increases.
• The risk of developing preeclampsia is highest during the first pregnancy.
• Becoming pregnant with a new partner each time also increases the risk of pre-eclampsia.
• The risk of pre-eclampsia increases if you become pregnant after the age of 40 or become pregnant at a young age.
• Being obese increases the risk of pre-eclampsia.
• Pre-eclampsia is more common in women who give birth to twins, triplets or more children at once.
• Having children at an age gap of less than two years or more than 10 years increases the risk of pre-eclampsia.
• Suffering from diseases such as chronic high blood pressure, migraine, type 1 or type 2 diabetes, kidney disease, tendency to form blood clots or lupus disease before you become pregnant increases the risk of pre-eclampsia.
• The risk of suffering from preeclampsia increases if the pregnancy is done in vitro (by the method of fertilization in the laboratory).

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The more severe the pre-eclampsia is and the earlier it occurs in pregnancy, the greater the risk of complications for the woman and the baby. Pre-eclampsia may require induced labor and delivery. Delivery by cesarean (C-section) may be necessary.Pre-eclampsia can cause the following complications:

• Fetal growth restriction: Preeclampsia affects the arteries that carry blood to the placenta. If the placenta does not receive enough blood, the baby receives insufficient blood, oxygen and nutrients. This can impede the growth of the fetus and lead to complications such as low birth weight or premature birth.
• Preterm birth: If you have preeclampsia, you may need to deliver early to save your life and your baby's life. Premature birth can cause other problems in your baby, such as breathing problems. Your doctor will tell you when is the ideal time for your delivery.
• Placental abruption: Pre-eclampsia increases the risk of placental abruption. This is a condition in which the placenta separates from the inner lining of the uterus before delivery. Severe placental abruption can cause heavy bleeding that can be fatal for both you and your baby.
• HELLP syndrome: In this, red blood cells are destroyed, liver enzymes increase and platelet count decreases. The more severe form of this syndrome is pre-eclampsia and it is dangerous for both mother and baby.
• Eclampsia: This occurs when preeclampsia is not controlled. Eclampsia is actually a combination of pre-eclampsia and seizures. Although there are no symptoms or signs to diagnose eclampsia, it can have serious consequences for both the mother and the baby. Therefore, the delivery process becomes necessary, no matter how long the pregnancy is left.
• Other organ damage: Pre-eclampsia can affect the kidneys, liver, lungs, heart or eyes. And it can cause strokes or other brain disorders. 
• Cardiovascular disease: Having pre-eclampsia can increase the risk of heart and blood vessel diseases in the future. To reduce the risk after delivery, try to keep your weight under control, eat a variety of fruits and vegetables, exercise regularly and do not smoke.

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Pre-eclampsia is a serious pregnancy condition that usually occurs after the 20th week of pregnancy. It involves high blood pressure and excessive amounts of protein in the urine, which can affect the kidneys and other organs. Symptoms may include swelling (especially of the face and hands), headache, blurred vision, and abdominal pain. If not controlled in time, it can be dangerous for both the mother and the baby, and in severe cases can lead to seizures (eclampsia). The main treatment of pre-eclampsia is possible only after the baby is born, but medications and monitoring are needed to control blood pressure during pregnancy.