Preeclampsia (Toxemia, Pregnancy-induced hypertension)

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What is Preeclampsia?

Preeclampsia is a pregnancy induced disease associated with elevated blood pressure and protein in the urine which presents in the second half of pregnancy.

Who gets Preeclampsia?

Preeclampsia is common and occurs in approximately 8% of all pregnancies.

The term eclampsia refers to the occurrence of epileptic seizures in pregnancy, not caused by trauma or other neurological disease. Hence, Pre-eclampsia is a condition before the occurrence of epileptic seizures.

Eclampsia occurs in 0.2-0.5% of all deliveries. 75% of cases occur before delivery, and 50% of post-partum eclamptic seizures occur in the first 48 hours after delivery (but may occur up to 6 weeks post-partum).

Predisposing Factors

Increased risk is associated with first pregnancies
Extremes of age - Very young mothers or advanced maternal age;
Multiple pregnancy-twins.
New sexual partner
Previous history or family history of the disease
Obese women
Women with a past history of diabetes, hypertension, or kidney disease.

The exact cause of preeclampsia is yet to be identified. Numerous theories of possible causes include: genetic, dietary, vascular (blood vessel), and autoimmune factors. No particular factor however, has been conclusively linked to the disorder. It has been described as a disease originating from the placenta but with widespread effects both for the mother and baby.

Progression

Preeclampsia refers to the combination of puffiness/swollen feet, high blood pressure and protein in the urine occurring after the 20th week of pregnancy and often occurs in first-time mothers. The disease can range from mild to severe in the way it presents. A very high blood pressure signifies severe disease. If severe and not treated, its complications can affect the kidneys, liver, clotting system, brain of the mother or cause growth restrictions in the fetus. This can pose a risk to the health of the mother and baby.

Mild Preeclampsia

Mildly raised blood pressure after 20th week with proteinuria but no effects on the brain.

Moderate-Severe Preeclampsia

Highly raised blood pressure with proteinuria and effects on the brain. The effects of preeclampsia on the brain include headache, dizziness, tinnitus, altered mental status, visual changes, and seizures. The visual changes may result from spasm of the blood vessels, insufficient blood supply, and hemorrhage in the visual centre of the brain, or from retinal detachment. Preeclampsia may also occur in women with pre-existing hypertension (superimposed preeclampsia), and in this situation the prognosis is poorer for mother and baby.

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