Hippocrates described a condition in pregnant women characterised by “headache accompanied by heaviness and convulsions”. But it was Bossier de Sauvages (1710-1795) who first used the term, “eclampsia”—a Greek word meaning “lightning”—alluding to how suddenly and unexpectedly convulsions may arise due to the disease.
Preeclampsia is quite simply; hypertension in pregnancy. It is defined as new-onset hypertension, usually accompanied by proteinuria (protein in the urine) which most often occurs after 20 weeks of pregnancy. It begins with hypertension and mild symptoms and progresses to more severe symptoms involving multiple organs and eclampsia. Eclampsia is the onset of generalised seizures in a pregnant women with preeclampsia.
Preeclampsia occurs in 2-10% of pregnant women across the world. This statistic is higher in developing countries including Nigeria where the prevalence can be as high as 16.7%. Over 70,000 women and 500,000 fetuses are lost every year to this condition.
Causes and Risk factors
For a disease that was first described by Hippocrates, the mechanism of how preeclampsia develops is still poorly understood. The principal theory is that it occurs as a result of an abnormal formation of the placenta. This results in the arteries of the uterus (womb) and placenta being constricted. Hypertension subsequently develops as the body attempts to compensate for the insufficient blood delivered to the fetus.This in turn, causes symptoms in other organs.
The risk factors for developing preeclampsia include:
- Previous history of preeclampsia
- Family history of preeclampsia
- Previous history of hypertension
- First pregnancy
- Multiple pregnancy (twins, triplets etc)
- Maternal age ≥ 35 years
- Race (Black, American Indian, Alaskan native)
- High body mass index (>30 before pregnancy)
- Other medical conditions (kidney disease, diabetes, autoimmune diseases)
Symptoms, Signs and Complications
Even though the pathophysiology of preeclampsia is not completely understood, its symptoms are well documented.
They include:
- Severe headaches
- Visual disturbances
- Upper abdominal pain
- Nausea or vomitting
- Reduced urine production
- Swelling of the face and hands
- High blood pressure
- Protein in urine
Preeclampsia can result in several complications for the pregnant woman including pulmonary edema, acute kidney injury, liver rupture, or cerebrovascular hemorrhage. The fetus may also suffer growth restriction, inadequate amniotic fluid, placental abruption and preterm birth. It can lead to mortality for both mother and fetus. HELLP (haemolysis, elevated liver enzymes, low platelet count) syndrome may occur during the pregnancy or after delivery.
Preeclampsia may progress to eclampsia, characterised by generalised tonic clonic contractions.
Prevailing over preeclampsia
Management of preeclampsia hinges on early diagnosis and intervention, focusing on adequate blood pressure control and seizure prevention. Pregnant women should attend antenatal appointments diligently and report any symptoms to their healthcare providers.
In addition to blood pressure measurement and a urinalysis to detect proteinuria, other tests may be required to ascertain the state of other organs. The fetus is also monitored closely.
Antihypertensives are given to lower the blood pressure. Seizure prevention medications are also prescribed. Hospitalisation may be required for optimal monitoring.
Unfortunately, the definitive treatment for preeclampsia is delivery of the baby. The risk of preterm delivery is weighed against the age of the pregnancy, fetal growth restriction, fetal distress, and severity of preeclampsia.
Preeclampsia usually resolves within a few hours after birth. However, the mother should be monitored closely in the weeks following delivery as preeclampsia can occur in the postpartum period.
Low-dose aspirin has been found to reduce the rate of occurrence of preeclampsia. Aspirin prophylaxis should be started at 12 to 28 weeks of pregnancy (ideally before 16 weeks) and continued until delivery in women with risk factors for preeclampsia.
It is essential that all pregnant women are educated on preeclampsia. Women from low socioeconomic backgrounds are more likely to die due to ignorance about the disease. Successful outcomes can be recorded with the combined efforts of healthcare providers, health educators and supportive communities.
Aisha Ibrahim
