The Mystery Called Pre-eclampsia

Pre-eclampsia is induced by pregnancy and generally begins after Week 20

"Approximately 10% of all recognized pregnancy complications are associated with hypertension-related diseases," said Prof. Motti Helek, Director of the Obstetrics, Gynecology and Reproductive Science Department at Hillel Yaffe Medical Center and a specialist in high-risk pregnancies. "The most common of these diseases is pre-eclampsia – at almost 70%. In the past, the rate of mortality or fetal injury caused by pre-eclampsia was extremely high. Although this condition is not risk-free today, medical advancements in obstetrics have facilitated early detection that has allowed us to control pre-eclampsia and enable a nearly normal pregnancy and delivery." 

What is pre-eclampsia? 

Pre-eclampsia is a multi-system condition, one symptom of which is hypertension. The condition is induced by pregnancy (although the reason is attributed to the placenta and not the fetus) and ends once the pregnancy has ended. The disease affects a large number of organs in the body, primarily four: the brain, liver, kidneys and placenta. 

For the most part, pre-eclampsia begins in the second half of the pregnancy (after Week 20).  Symptoms may include severe headaches, pressure on the eyes, blurred vision, flashes before the eyes, visual deficits, visual disturbances and upper abdominal pain. In addition, symptoms such as contractions, abdominal pain and bleeding might occur. Accordingly, tests conducted on a woman will reveal elevated blood pressure levels, presence of protein in the urine (in problematic pathological levels), onset of retinal edema to retinal detachment, anasarca in the legs, hands and face (fluid retention throughout the body), pulmonary edema, etc.   

Pre-eclampsia generally affects blood vessels throughout the body, and particularly the aforementioned organs. Other symptoms include cerebral hemorrhage, bleeding in the liver, severe kidney problems and vascular stenosis in the placenta. This stenosis might result in fetal injury, in hindering blood flow to the fetus, ultimately resulting in severe fetal growth restriction.  

Level of Severity of Pre-eclampsia  

Pre-eclampsia can be mild or severe. Severity is determined according to the severity of symptoms and laboratory and imaging test results.  

In severe pre-eclampsia, placental abruption might occur and result in significant and potentially life-threatening blood loss to the mother. In addition, the fetus might suffer from a potentially life-threatening restriction of blood supply. The onset of edema and cerebral hemorrhages might cause a woman who suffers from pre-eclampsia to lose consciousness and trigger general seizures and in severe cases – death.   

In mild pre-eclampsia, the disease manifests itself in hypertension of 140-150 (high) to 90-100 (low) and increased urine protein levels, although not at life-threatening levels. Laboratory tests carried out in women with mild pre-eclampsia will not reveal in kidney or liver dysfunction.  

Why does this happen and what causes pre-eclampsia? 

"I don't know if pre-eclampsia can be called a 'mystery' condition in the truest sense of the word," said Prof. Helek, "but the cause of the disease is not definitively known. What is clear is that it originates in the placental blood vessels, and there are definite risk factors and characteristics of its onset, some of which may help in the diagnosis." 

The characteristics and risk factors for pre-eclampsia include: 

• Women with diseases such as chronic hypertension or diabetes 
• Woman's age: 35+ or below 18 
• Multiple fetus pregnancy 
• First pregnancy 
• Women of African descent 
• Women who suffered from pre-eclampsia in their first first pregnancy 

Early detection is made first based on the aforementioned characteristics and secondly through regular blood pressure and urine protein testing during pregnancy. Pregnant women who are defined as having high-risk pregnancies or who fall into the aforementioned criteria must take these tests on a weekly basis starting in Weeks 26-28. If blood pressure is higher than 140/ 90 or urine protein level is + 1 or more, the woman must contact the attending physician for an evaluation. 

Most women suspected of suffering from pre-eclampsia are hospitalized so that doctors can monitor the mother and fetus in the high-risk pregnancy unit in the hospital. "With mild pre-eclampsia," explained Prof. Helek, "the pregnancy can continue under close supervision until the woman reaches as close to her due date as possible. These women are generally induced to deliver in Weeks 37-38."  

If the pre-eclampsia is severe, the woman must be delivered due to the possible risks. Continuation of the pregnancy under this condition might endanger the lives of both the mother and unborn child. 

The decision on when to deliver the child in women with severe pre-eclampsia is made based on the week of the pregnancy. If the disease began very early on, such as in Week 27-28, doctors should consider delaying delivery for at least 48 hours until a steroid has been administered that will help the fetus's lungs mature. Under special circumstances, when the mother and fetus are stable, they can be placed under conservative and meticulous monitoring once the mother has been hospitalized in the high-risk pregnancy unit until the end of the pregnancy. 

Giving Birth under the Cloud of Pre-eclampsia 

When it is clear that the baby must be delivered and the mother is experiencing severe pre-eclampsia, there are three guidelines to which the medical team must adhere: 

1. Inducing labor and removing the entire placenta. Since pre-eclampsia is attributed to a problem created by the placenta, ending pre-eclampsia largely depends on halting the pathological process that is exacerbating the woman's condition – i.e. removal of the entire placenta and "emptying the uterus." 
2. Prevention and, if necessary, treatment of seizures. Part of the treatment of pre-eclampsia involves the administration of special drugs that affect the brain and prevent seizures. 
3. Control and treatment of hypertension. In and of itself, high blood pressure values might trigger a stroke from which the woman might not recover. Accordingly, blood pressure values must be strictly monitored and intravenous treatment with a variety of designated drugs must be administered. 

After giving birth, the woman remains in the delivery room for at least 24 hours for monitoring to prevent seizures (which might occur after delivery) and to control hypertension. During these hours, the woman's condition is re-evaluated. If the woman displays signs of recovery, she is transferred for continued observation to the maternity ward. In severe cases, treatment is continued in the ICU unit until the woman has fully recovered.  

Following initial recovery, the woman is discharged with instructions for further monitoring for several weeks until the disease completely passes. Pre-eclampsia does not last beyond 12 weeks after birth. 

Obstetrics, Gynecology and Reproductive Science Department»