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All About Pre-Eclampsia and Eclampsia 2005/02/14

Posted by Dave in Baby, Health.
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I was told just before I left the office that Ruth’s condition has worsened, and that she will be induced tomorrow morning, so I decided to investigate ‘Pre-eclampsia’ on the web… here’s what I found out…

  • ‘Pre-eclampsia’ [pron. “pree’-eh’-klamp’-shah”] cannot be avoided, and no one really knows why some women develop the disease, so it is impossible to prevent it.

It affects between 10 per cent & 20 per cent of all pregnancies, and is a very dangerous and serious disease; it is, globally, the leading cause of maternal and infant illness and death — and by conservative estimates is reponsible for some 76 000 deaths/year.

However, if it is detected early, this disease can be managed.

The early symptoms are —

  • noticeable swelling and puffiness (‘nondependent oedema’ [pron. ee-deemah] — hands and face after waking — as opposed to ‘dependent oedema’, such as normal swollen ankles) ,
  • unintentional weight gain (over 1 kg/week, or a sudden weight gain over a couple of days)
  • high blood pressure (140/90 mm mercury or greater), and
  • protein in the urine (‘proteinuria’).
    [Ruth has all these]

However, it is common for women to only be aware of the weight gain and swelling symptoms. This is why it is so important to have regular ‘antenatal’ checks on urine and blood pressure to detect the disease as early as possible. [This is true: Ruth feels perfectly fine!]

  • ‘Pre-eclampsia’ indicates that there is something fundamentally wrong with the ‘placenta’.

The advanced symptoms of ‘Pre-eclampsia’–

  • dizziness, [No]
  • visual disturbances, [No]
  • severe headaches (resistant to headache pills), [No]
  • severe pain under the ribs (‘Epigastric’) — with or without sickness, [No]
  • The ‘platelet’ count is less than 100 000/FL (‘thrombocytopenia’), [Don’t know] and
    Liver function tests are elevated. [Don’t know]
A woman has a higher risk of ‘Pre-eclampsia’ if —

  • She is black, [No]
  • she is under 20 or over 35,[No]
  • she is having her first baby, [Yes]
  • she is having a first baby with a new partner, [No]
  • she is expecting multiple babies, [No]
  • she has had high blood pressure, [No]
  • she has had diabetes, [No]
  • she has had kidney (‘renal’) disease, and/or [No]
  • there is a maternal family history of the disease. [No]

‘Eclampsia’–

‘Eclampsia’ occurs in between 1 in 2000 and 1 in 3000 pregnancies, and has the same symptoms as ‘Pre-eclampsia’, but also has the following symptoms:

  • seizures, convulsions — involuntary movements (‘tonic-clonic’ seizures) occur,
  • severe agitation,
  • Breathing (respiration) may cease for brief periods (‘apnoea’),
  • Unconsciousness for a variable period of time ,
  • possible ‘musculoskeletal’ aches and pains after an event caused by ‘trauma’, (physical evidence of ‘trauma’ may be noted),
  • reduced urine,
  • jaundice,
  • the relaxation phase of deep-tendon reflexes may be prolonged, and
  • infrequently, an eye examination may note ‘retinal’ changes caused by ‘hypertension’.

Tests

‘Eclampsia’ or ‘Pre-eclampsia’ may also alter the results of the following tests:

  • Hematocrit,
  • Serum chloride,
  • Uric acid,
  • Creatinine,
  • CBC, and
  • Blood differential.

Treatment

The treatment is bed rest followed by delivery as soon as it is safe for the foetus. The goal is to manage the condition until 36 weeks of the pregnancy have passed. [Ruth’s only just passed the 34th week]

The condition is then relieved with the delivery of the baby, induced or otherwise.

Patients with ‘Pre-eclampsia’ may occasionally be managed on an ‘outpatient’ basis with careful monitoring of blood pressure, urine protein, and weight gain, however a ‘take no chances’ policy usually indicated the patient being admitted to an ‘antenatal’ hospital ward so that their condition can be checked regularly and they can have rapid treatment if things suddenly get worse. [Ruth has “Suddenly got worse”, and the baby is to be induced at 34 weeks]

Medication may be used to lower the elevated blood pressure, but this does not prevent the leakage of protein into the urine. [Yes, it dropped Ruth from 150/93 to 120/60, but they say it has not stabilised]

Because the risk of ‘Eclampsia’ is unpredictable — and often not easily related to physical signs (such as the degree of high blood pressure), an ‘anticonvulsant’ (seizure-prevention medication) is usually given to women in labour with ‘Pre-eclampsia’. ‘Magnesium sulphate’ is a safe drug for both the mother and the foetus when used to prevent seizures. [Don’t know about this]

Normal or Induced Delivery is the treatment of choice for ‘Eclampsia’ in a pregnancy over 28 weeks. [Ruth’s being induced]

For pregnancies less than 24 weeks, the induction of labour is recommended, although the likelihood of a viable foetus is minimal. [Ruth’s being induced tomorrow morning, but at 34 weeks, we’re hoping the foetus will be ‘viable’]

Prolonging such pregnancies results in maternal complications as well as infant death in approximately 87 per cent of the cases. [We’re over the 24 week mark, so we’re hoping mother and baby will be just fine]

Pregnancies between 24 and 28 weeks gestation present a ‘grey zone’, and conservative management may be attempted, with monitoring for maternal and foetal complications.

Delivery may be induced if any of the following occur:

  • ‘Diastolic blood pressure’ of greater than 110 mm of mercury consistently for a 6-hour period,
  • Persistent or severe headache, [No]
  • ‘Epigastric’ (stomach region) pain, [No]
  • Abnormal liver function tests,
  • Rising ‘serum creatinine’,
  • ‘HELLP’ syndrome, [Well, Ruth has had Steroid injections…]
  • ‘Pulmonary oedema’ (fluid in lungs) ,
  • ‘Thrombocytopenia’,
  • Abnormal foetal heart pattern,
  • Failure of foetal growth noted by ‘ultrasound’, or
  • ‘Eclampsia’.

‘Pre-eclampsia’ may develop into ‘Eclampsia’ — the occurrence of seizures. ‘Eclampsia’ may lead to complications from ‘trauma’ — or even death. The risk for ‘placenta abruptio’ is also increased with ‘Pre-eclampsia’ or ‘Eclampsia’.

Foetal complications caused by prematurity at the time of delivery may occur, and foetal or perinatal (close to birth) deaths are high and generally decrease as the maturity of the foetus increases. [Let’s hope 34 weeks is long enough, I’m worried because it is not the 36th week]

Maternal deaths caused by ‘Pre-eclampsia’ or ‘Eclampsia’ are less common. [They had better be]

The risk of recurrent ‘Pre-eclampsia’ in later pregnancies is approximately 33 per cent. ‘Pre-eclampsia’ does not appear to lead to chronic high blood pressure in women. [This means that there is a two-thirds chance of further pregnancies for Ruth being without all this scary stuff, and that there are no long-term hypertension effects].

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Comments»

1. Starts and Stops « devine - 2007/02/15

[…] said things had got even worse with my wee Ruth’s pregnancy that due to the onset of eclampsia they are no longer going to induce the birth this morning as planned, but instead they had to go […]

2. Gwen Sweetman - 2007/03/06

I just received a call from my daughter’s obstetrician with the results of her autopsy. At 25 years of age, following her second C-section, she died from complications of eclampsia with microthrombi found in her lungs, liver, and kidneys. If anyone has any information regarding this condition I would certainly appreciate a response.

3. Goodbye Gary « devine - 2007/07/04

[…] shared some amazing co-incidences — with their first child, his wife got pre-eclampsia, and the baby was a wee girl born very prematurely at the same hospital as us — they also […]

4. The Pre-eclampsia site - 2007/09/17

A very moving article, the link below is also very emotional:
http://www.aspects.com/~pre-eclampsia/ruth.htm

5. Claire - 2011/03/29

http://www.bbc.co.uk/news/health-12816571
Amazing
Scientists say they have identified genetic errors that appear to increase a pregnant woman’s chance of getting the potentially life-threatening condition called pre-eclampsia.


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