Preeclampsia- Is it preventable? Who are at risk??
How to prevent preeclampsia?
Eclampsia- The thunderbolt!
This story goes back to my days as a postgraduate in Obstetrics and Gynaecology. I was on the night shift, and a pregnant woman in her 8th month was brought on a stretcher in a semi-conscious state. She was unaware of her surroundings and was in a state of confusion. Her blood pressure was too high!! She had had a convulsion on the way to the hospital- medical term- "Eclampsia"- meaning the thunderbolt in greek! It was her second episode since morning. After the first convulsion, the family didn't get her to the hospital, thinking she would be alright after rest. Unfortunately, she had severe headaches and blurred vision- now they were worried and brought her to the hospital. On the way, she had a convulsion. I am sure all of my Obgyn friends and colleagues have seen such incidence during their training or practice. We admitted the pregnant lady, stabilised her with medications and delivered the baby the same night. Thankfully she didn't have further episodes of convulsions, and her blood pressure was under control. The baby was stable but was under close observation.
Eclampsia and preeclampsia are conditions specific to pregnancy and the period immediately after childbirth. Some women develop high blood pressure and protein loss in urine during the second half of pregnancy called "preeclampsia". If preeclampsia is not appropriately managed, the pregnant woman can have seizures or convulsions, called "eclampsia".
Preeclampsia is not uncommon; it occurs in 4-8 per cent of all pregnancies. It can affect the mother in several ways- high blood pressure, damage to organ systems like brain, heart, liver and kidneys, and lead to convulsions and rarely death of the pregnant woman. It can affect the baby's growth and lead to premature delivery as the delivery of the placenta is the only cure for preeclampsia. Repeated seizures are a threat to baby’s life in the womb.
Much research has gone into finding an effective way to manage preeclampsia and eclampsia. Although we can effectively manage the condition, there are several instances where we deliver the baby prematurely to prevent further damage to the mother's and baby's health. Premature babies can have several difficulties after birth- breathing difficulties, bleeding in the brain and intestines, infections, feeding difficulties- to name a few. The baby has to spend weeks and months in the baby intensive care unit. What if we could prevent preeclampsia? That would be the best way to improve the outcomes for the mother and the baby, and this is possible now!
There are several identified risk factors in the mother which could put them at a higher risk of developing preeclampsia. After identifying high-risk women, starting them on Low dose aspirin(150mg) before 16 weeks has proven to reduce the risk of preeclampsia before 32 weeks by 90 per cent and preeclampsia before 37 weeks by 60 per cent. This will prevent premature delivery of the baby and associated risks.
The risk calculation is performed by considering the mother's history of any previous pregnancy with preeclampsia, age, height, weight, medical problems like diabetes, combining it with the mean arterial blood pressure and the blood flow in the arteries that supply the uterus or the womb. An ultrasound scan performed in the third month is valuable in providing information about the blood flow in the uterine arteries. Software is used to calculate the risk using the above data.
The preeclampsia risk is calculated during the third month or NT/ NB scan. Any risk above 1:100, e.g., 1:60, is considered high risk and these women are started on 150 mg of Aspirin before 16 weeks of pregnancy. Any risk below 1:100, e.g., 1:300, is regarded as low risk, and these women will have regular antenatal follow up. With this, we hope to improve the outcomes for the mother and babies.