Management of Preeclampsia

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction :

An issue during pregnancy is preeclampsia. Preeclampsia can result in high blood pressure, proteinuria, a high quantity of protein in the urine that indicates renal impairment, and other symptoms of organ damage. Preeclampsia frequently develops in pregnant women whose blood pressure was previously within the normal range after 20 weeks of pregnancy. Preeclampsia can lead to significant, potentially deadly consequences for the mother and the fetus if it is not managed. For the management of preeclampsia, a baby’s early delivery is frequently advised. When you should give birth will depend on how far along you are in your pregnancy and the severity of your preeclampsia. Preeclampsia treatment before delivery includes careful monitoring and medications to lower blood pressure and control issues.

After giving delivery, preeclampsia, also referred to as postpartum preeclampsia, can develop.

Preeclampsia:

Preeclampsia can turn into eclampsia during pregnancy, which can result in seizures. Attending your prenatal medical appointments is advised so they may check your blood pressure, blood, and urine. Complications can be lethal.

A serious side effect of preeclampsia is eclampsia. An uncommon yet fatal condition, elevated blood pressure during pregnancy can cause seizures. Seizures, which are periods of aberrant brain activity, can cause spells of staring, sleepiness, and convulsions (violent shaking). The prevalence of preeclampsia is one in 200 females. Despite not having a history of seizures, eclampsia can nonetheless manifest in a person.

In This Article

What distinguishes preeclampsia from Eclampsia?

Eclampsia is the medical term for preeclampsia that is severe enough to cause seizures. Although it can occur without preeclampsia symptoms, it is regarded as a complication of preeclampsia. The expecting mother may become confused and disoriented as a result of these seizures, or they may place her in a coma. It may occasionally cause a stroke or death. Preeclampsia is typically treated before it develops into eclampsia. Throughout your pregnancy, your obstetrician will keep a careful eye on you and might even prescribe medicine. Giving birth to a child is the sole cure for both illnesses.

Causes of Preeclampsia

The exact cause of preeclampsia is likely a combination of several factors. The placenta, which feeds the fetus during pregnancy, is where experts think it starts. Early in pregnancy, new blood vessels start to form and grow to nourish and oxygenate the placenta. It appears that in preeclamptic women, these blood vessels do not develop or function normally. If the blood supply to the placenta is compromised, the mother’s blood pressure may not be effectively managed.

Other issues that contribute to high blood pressure during pregnancy:

One condition related to high blood pressure (hypertension) that can occur during pregnancy is preeclampsia. Additional problems may also develop:

Gestational hypertension is a condition of elevated blood pressure that starts to develop after 20 weeks of pregnancy and doesn't involve any organ or kidney issues. Preeclampsia can occur in certain pregnant women with gestational hypertension.
When high blood pressure appears before 20 weeks of pregnancy or already exists at the time of conception, it is referred to as chronic hypertension. Chronic hypertension is high blood pressure that lasts longer than three months following pregnancy.
Before getting pregnant, women who had been diagnosed with chronic high blood pressure ran the risk of preeclampsia, escalating hypertension, protein levels in the urine, and other pregnancy-related issues.

Management of Preeclampsia Diagnosis

Preeclampsia is most commonly diagnosed in pregnant women after 20 weeks if they have high blood pressure and at least one of the symptoms listed below:
Proteinuria, a symptom of renal disease, is present in the urine.
Any indications of renal issues
A deficiency in blood platelets
Elevated liver enzyme levels signify a compromised liver.
Lung fluid buildup (pulmonary edema)
Headaches that first appear and even after taking painkillers don't go away
New eyesight problems
Elevated blood pressure

A blood pressure reading consists of two digits. The first value is the systolic pressure, or blood pressure, which is determined when the heart is contracting. The second number is the diastolic pressure, or blood pressure, when the heart is at rest.

High blood pressure during pregnancy is deemed to be present if either the systolic pressure or the diastolic pressure is 140 mm Hg or greater.

Several factors might affect your blood pressure. If you show up for your appointment with elevated blood pressure, your doctor will likely take another reading four hours later for confirmation of the diagnosis.

Further examinations:

For the management of preeclampsia, your doctor will request more testing if you have high blood pressure to look for other preeclampsia symptoms:

1. Blood test :

In more severe or recurring events, the doctor might suggest a medicine called fluconazole as an oral antifungal medicine.

2. Urine test :

To determine how effectively your kidneys are functioning, your doctor may request either a 24-hour urine sample or a single urine sample.

3. Pregnancy ultrasound :

Your primary care physician will probably keep a careful eye on the development of your child, typically via ultrasound. The images of your child taken during the ultrasound examination can be used to estimate the baby’s weight and the volume of amniotic fluid in the uterus.

4. A non-stress test or a biophysical profile :

A short procedure called a nonstress test can quickly ascertain how your baby’s heart rate reacts to movement. An ultrasound is used during a biophysical profile to measure your unborn child’s respiration, muscle tone, movement, and amniotic fluid volume.

5. Treatment :

Typically management of preeclampsia is done by giving delivery or waiting until the perfect time to do so. This choice, which you and your doctor will make together, will be influenced by the severity of your preeclampsia, your child’s gestational age, and your overall health. If your preeclampsia is mild, your doctor may see you frequently to check on your blood pressure, any changes in your signs or symptoms, and the well-being of your unborn child. You’ll likely be requested to take your blood pressure every day at home.

Severe Preeclampsia Management

If you have severe preeclampsia, you must remain in the hospital so that your blood pressure and other effects may be watched. Your doctor will periodically assess the general health and growth of your infant for the management of severe preeclampsia

Severe preeclampsia is usually treated with the medications listed below:

1. Surgical management of preeclampsia:

If your preeclampsia worsens, you could have to deliver your child before the due date. Your doctor may perform a cesarean section to deliver your child or induce labor, which is known as surgical management of preeclampsia. After delivery, Preeclampsia frequently disappears. Preeclampsia symptoms, however, can linger or worsen after birth.

2. Delivery:

For the management of severe preeclampsia, your doctor might suggest preterm delivery after 37 weeks if your preeclampsia is not severe. Depending on the severity of the issues and the baby’s health and readiness, your doctor may advise delivery before 37 weeks if you have severe preeclampsia.

The severity of the illness, the baby’s gestational age, and other factors that you would discuss with your healthcare professional determine whether a vaginal delivery or a cesarean section is necessary.

3. After the delivery:

You must be closely monitored for elevated levels of blood pressure and other preeclampsia symptoms after giving birth. When to contact an ambulance if you experience postpartum preeclampsia symptoms, including severe headaches, visual issues, severe abdominal pain, nausea, or vomiting, will be explained to you before you leave the hospital.

Management of eclampsia

1. Why does eclampsia develop?

Preeclampsia frequently leads to eclampsia. Your blood vessels are under pressure due to high blood pressure (caused by preeclampsia). Your brain could be swollen, which could cause seizures. Your risk for eclampsia can be increased by genetics and food.

2. Management of eclampsia:

Giving delivery is the most effective treatment for eclampsia. Inducing labor is typically the best option if the fetus is 37 weeks or more in the pregnancy. If both you and the fetus are in good health, you may still deliver vaginally. For eclampsia during pregnancy, your doctor might recommend drugs like:

A) Infusions of Magnesium sulphate or anticonvulsant drugs are used to prevent seizures.

Anti-seizure drugs like magnesium sulfate are frequently advised by doctors in severe preeclampsia instances. A mineral called magnesium sulfate helps preclamptic women's seizure risks. The drug will be infused by a medical professional.
Additionally, it can sometimes extend pregnancy by up to two days. This gives corticosteroid medications time to enhance the infant's lung health.
Usually, magnesium sulfate starts working right away. Until roughly 24 hours after the baby is delivered, it is typically administered. Hospitalization is required for women receiving magnesium sulfate to closely monitor their medication.
Although management of eclampsia with MgSO4 is widely used and effective, its exact mode of action is yet unknown. There have been several proposed methods of action, including blood-brain barrier protection, central anticonvulsant activity, and functioning as a vasodilator with activities either peripherally or in the cerebral circulation to reduce vasoconstriction.

B) To reduce blood pressure with medication.

C) Corticosteroids support and strengthen the fetus’s lungs throughout development

Management of Postpartum hypertension

Preeclampsia postpartum is a disorder that can develop up to six weeks after the birth of your child. A person with this uncommon illness experiences high blood pressure and excessive quantities of protein in their urine. If left untreated, this illness is dangerous and can cause death, brain damage, and stroke. Early detection and prompt medical intervention are crucial for the effective management of eclampsia and preeclampsia

The best way for the postpartum preeclampsia management:

The Following tests may be carried out if your doctor suspects you have postpartum preeclampsia:

Treatment:

If your doctor determines you have postpartum preeclampsia, the following treatments may be suggested:

Using blood pressure medication to reduce your blood pressure.
Preventing seizures, which are one of the most frequent side effects of postpartum Preeclampsia, with anti-seizure medication such as magnesium sulfate.
Drugs that act as blood thinners or anticoagulants to lower the risk of blood clots.
If you are breast- or chest-feeding, let your doctor know so they can determine whether the drugs are safe for your child.

Postpartum Hypertension

When a new mother has postpartum hypertension, her blood pressure is excessively high. Pregnancy-induced hypertension or postpartum hypertension is high blood pressure that develops after childbirth (systolic pressure of 140 mm Hg or higher and/or diastolic pressure of 90 mm Hg or higher).

Follow these guidelines when keeping an eye on your blood pressure:

Normal: A value of 120/80 indicates normal, healthy blood pressure. Once we pass that, the degree to which the brain can control blood flow varies depending on the patient.
High: Your blood pressure may be 140/90 during pregnancy and the first few weeks following delivery. Although high, this is not serious. You should monitor your blood pressure along with your doctor to make sure it doesn't rise.
Medical Emergency: A blood pressure reading of 160/110 or higher indicates a serious medical condition.
If you are breast- or chest-feeding, let your doctor know so they can determine whether the drugs are safe for your child.

1. Management of Postpartum hypertension:

Oral medications can be used for postpartum hypertension management. In some circumstances, your doctor might advise magnesium therapy to stop preeclampsia-related seizures. Patients with very high postpartum blood pressure who attend their local doctor’s office should be taken to a hospital to receive treatment and monitoring.

2. Management of Chronic hypertension:

Despite not frequently being an emergency, chronic hypertension poses a long-term health risk that needs to be managed. Most individuals can lower their blood pressure to a healthy level by taking medication, exercising, and making dietary changes. Getting blood pressure to a healthier level involves a combination of factors, including increasing exercise and lowering sodium.

Conclusion

Proteinuria and newly developed hypertension are symptoms of preeclampsia beyond 20 weeks of pregnancy, which may be associated with a variety of organ dysfunctions. The exact cause of preeclampsia is still unknown despite the several possibilities that have been proposed.

Preeclampsia, which affects both the mother and the fetus, is one of the main causes of maternal sickness and even fatality.

Preeclampsia should be periodically tested for in pregnant women, and those who are at high risk should be visited by a specialist early on. At all levels of the maternity services as well as for the women themselves, awareness of the signs and symptoms is crucial. Once pre-eclampsia manifests, quick examination and monitoring referrals will help guarantee that women receive the proper care.