Thursday, 16 June 2016

Pre-eclampsia Diagnosis: Suppressing Mother Mortality Rate

Today, preeclampsia is rated number three in the factors of mother mortality, following thromboembolism (blood coagulation in the blood vessels) and bleeding. In addition to increasing the risk of death in mothers, preeclampsia may also cause deformities and fetal death, as well as increasing the risk of cardiovascular diseases (heart and blood vessel diseases) in mothers in the future.

Preeclampsia, "disease of theory"

Preeclampsia is one type of hypertension during pregnancy, also dubbed the "disease of theory" due to the large number of theories attempting to explain what causes preeclampsia. Even until today, causes of preeclampsia have not been comprehensively established. Still, there are a number of risk factors suspected to trigger preeclampsia, among others:

  • Microvascular (small blood vessels) diseases such as chronic hypertension, kidney disease, diabetes mellitus and joint diseases (lupus, rheumatoid arthritis)
  • Thrombophilia (blood disease due to excessive thrombocytes), either inherited or developed
  • Obesity and insulin resistance
  • Pregnancy at the age of older than 40 years old
  • A history of preeclampsia and cardiovascular in the family
  • A history of problems during past pregnancy(ies) (hindered fetal development, placental abruption, fetal death)

Each of the factors listed above leads to different level of preeclampsia risk, depending on the patient' s medical condition and severity. A number of researches have also proven that if a pregnant woman had experienced preeclampsia once, she is exposed to a high risk of recurring preeclampsia during the next pregnancy.

Placenta, the key to preeclampsia

Some factors that currently are considered as contributing to preeclampsia include placental ischemia (oxygen deficiency in the placenta), immune response, genetic factors, and vascular diseases in mothers (such as diabetes mellitus, chronic hypertension, and vascular and joint tissue disorders). These factors are not stand-alone, but are interconnected in causing preeclampsia.

Generally speaking, the process of preeclampsia involves two phases:

  • Asymptomatic phase

Characterized by abnormal placenta during the first trimester of pregnancy, leading to placental insufficiency (disorders) and the release of substances from the placenta into the mother' s blood circulation (maternal circulation).

  • Symptomatic phase or maternal syndrome

The release of placental substances into the maternal circulation will reach its climax with the emergence of clinical symptoms of preeclampsia, known as the maternal syndrome. The clinical symptoms commonly emerge after pregnancy age of 20 weeks, and include hypertension, proteinuria (increased amount of albumin in the urine) and hindered fetal development (fetal syndrome).

Preeclampsia only occurs if placenta is present, even without fetus in it, as in mola hydatidosa (molar pregnancy). Preeclampsia will heal without help once the placenta has been removed.

How to detect preeclampsia?

The beginning of preeclampsia is commonly without the presence of symptoms (asymptomatic). Complaints may be experienced, but only after preeclampsia has developed. Complaints may be, among others: headache, vision problems, epigastric pain, weight gain, and oedema (swelling) in the arms and face.

Serious preeclampsia is often accompanied by clinical symptoms such as oliguria or reduced volume/amount of urine (< 500ml urine/24 hours), vision problems, cyanosis (the appearance of a blue or purple coloration of the skin due to reduced level of oxygen in the blood), epigastric pain (upper middle part of the abdomen), liver dysfunction, thrombocytopenia (low amount of thrombocytes) and hindered fetal development.

As such, regular consultation with the obstetrician during pregnancy is strongly recommended to allow early detection of preeclampsia. Anticipating the development of preeclampsia during pregnancy is important as either a preventive measure or an early remark for pregnancies where high risk of preeclampsia is present. This way, fetal deformities and mother and fetal mortality can be prevented and avoided.