Pre-eclampsia is a serious complication of pregnancy which is characterized by an increase in blood pressure and the appearance of protein in the urine. Anh-Chi Ton, midwife, gives us the keys to better understand her.
Pre-eclampsia affects 40,000 women each year and is responsible forone third of very premature births, according to Inserm figures. Anh-Chi Ton, midwife, reminds us that this disease is really specific to pregnancy : “Pre-eclampsia does not occur outside of pregnancy and heals in the postpartum period. It is characterized by the combination of two criteria: a high blood pressure (> 140 / 90mmHg) and the presence of protein in the urine better than 0.3 g / 24h)“. If the pregnant women are becoming better informed, the disease and its symptoms however, remain little known to the general public. In most cases, expectant mothers give birth to a healthy baby and get back on their feet very quickly, but the risk of complications for both her and the child are very real, and potentially serious. Second cause of maternal death, pre-eclampsia is therefore the object of all the attention of the medical profession. If a doctor or midwife suspects, the expectant mother is immediately taken care of.
Pre-eclampsia can cause a lot of symptoms. During pregnancy, it is therefore very important that the expectant mother be attentive to signs that her body sends her, and that she does not hesitate to consult in the event of unusual, persistent or worsening signs. The midwife specifies that “hypertension can manifest as headache, tinnitus or phosphenes (the appearance of spots in front of the visual field). Proteinuria, even if there is sometimes a decrease in urine in case of worsening, is however generally asymptomatic, hence the need for the urine strip test“Other symptoms may occur with pre-eclampsia during pregnancy:
- Edema of sudden onset, especially on the head, hands and feet, which starts to swell. Concretely, one feels difficulties in putting on shoes or usual rings.
- Pain in the epigastric bar or in the liver
- Significant nausea and vomiting
- Bright osteotendinous reflexes (in case of worsening)
- Other symptoms of complications will only be seen on a blood test
For the baby, pre-eclampsia is sometimes associated with stunted growth visible on ultrasound.
Pre-eclampsia mostly occurs at third trimester of pregnancy. We talk about early pre-eclampsia before 34 weeks of amenorrhea (in 50% of cases), but these are very feared by doctors because the risks associated with prematurity are then greater.
Some expectant mothers are more at risk than others of develop pre-eclampsia. Anh-Chi Ton details the risk factors The most common :”Maternal age, multiple pregnancy, obesity, diabetes, history of hypertension or pre-eclampsia in a previous pregnancy, autoimmune disease, history of thrombosis or kidney disease, but also a family history in the mother or a sister“. The midwife also draws attention to risk factors from an immunological point of view, pre-eclampsia being linked to a dysfunction of the placenta which will less well ensure the exchange of oxygen and protein and release toxic substances in the maternal body. “The mother’s body can treat the placenta, 50% genetically from the father, as a foreign body. There is therefore a greater risk of pre-eclampsia with a new partner, in the case of a pregnancy obtained with insemination by sperm from a donor, if the couple has long used condoms“specifies the specialist.
Pre-eclampsia can progress quickly, especially during the third trimester of pregnancy and cause serious complications in 10% of the cases then bringing into play, in the short term, the vital prognosis of the mother and her future baby. For the child, the major risk is that of stunting and prematurity, when childbirth must be started early. The midwife explains that the decrease in the amount of amniotic fluid also has consequences for the child: “it must adapt to this defect in intake and oxygenation and can therefore be overdue“. In case of acute complications or long or brutal suffering, pre-eclampsia can unfortunately lead to fetal death.
In the mother, pre-eclampsia can have an impact on the kidneys (glomerular lesions), liver (microthrombosis), the brain (micro thromboses). It can also cause bleeding disorders and various complications such as HELLP syndrome (severe liver damage), CIVD (pathological activation of coagulation), a hematoma retro placenta or a detachment of the retina which can lead to blindness. The other major complication of pre-eclampsia is of course eclampsia, fortunately rare: “It is a fatal complication which will lead to convulsions, sometimes coma, but can also cause cerebral hemorrhage which is the main cause of death of mothers. This accident requires an emergency delivery“.
Pre-eclampsia as such is not treatable, even if there are treatments to lower the blood pressure. The future mother is then hospitalized and monitored with regular exams (blood pressure, proteinuria, uricemia and serum creatinine). The baby’s vitality is also constantly monitored, as is the amount of amniotic fluid. The midwife recalls that “the only real treatment is termination of pregnancy, especially delivery of the placenta. We can therefore start a delivery prematurely to save the mother or child“.
After pre-eclampsia, the young mother will remain under close surveillance for several weeks. As long as the high blood pressure persists, she will have to follow a antihypertensive treatment. A medical check is then necessary 6 weeks after delivery to make sure everything is back to normal. Pre-eclampsia can also increase the long-term risk of developing certain pathologies such as chronic hypertension, cardiovascular accident, recurrence of pre-eclampsia during a subsequent pregnancy or kidney disease. Blood pressure monitoring and a regular search for protein in the urine are essential, as well as research into other cardiovascular risk factors.
thanks to Anh-Chi Ton, midwife