Hypertensive disorders in pregnant women
HYPERTENSIVE disorders in pregnant women are quite common. Among the most life-threatening of these are preeclampsia and eclampsia — the latter usually being the advanced stage of mismanaged or untreated preeclampsia.
“The most common late obstetric complication in Jamaican women is preeclampsia, which can be described as high blood pressure in the presence of passing protein in the urine in the latter half of the pregnancy, while eclampsia is the onset of generalised seizures or unexplained coma in the latter half of pregnancy or in the postpartum period (usually within 25 days after birth),” explained Dr Keisha Buchanan, obstetrician-gynaecologist at ICON Medical Centre.
She said that eclampsia is seen in just 1.5 per cent of pregnancies, and is an obstetric emergency, with 80 per cent of cases happening during labour or within the first 48 hours after delivery.
“Preeclampsia is characterised by headaches, blurred vision or spots in front of the eyes, temporary vision loss, stomach pains, nausea, vomiting, sudden swelling of the legs, hands or face, difficulty breathing, and decreased foetal movements,” Dr Buchanan outlined.
She cautioned women to seek immediate medical attention as soon as these symptoms occur.
In the case of eclampsia, Dr Buchanan noted that it may be preceded by foetal signs or symptoms such as slowing foetal growth and a decrease in the quantity of the amniotic fluid.
“These signs are usually detected during your obstetric visits and through doing an ultrasound. They usually occur in the presence of high blood pressure. At times, restricted foetal growth may precede the development of high blood pressure,” Dr Buchanan said.
But eclampsia is not always linked to preeclampsia; in fact, Dr Buchanan said that this may happen suddenly and without prior warning or prior illness. Eclampsia may be triggered by conditions such as pre-existing high blood pressure, obesity, extremes of maternal age (for example, if the mother is over 40 or under 20), preeclampsia in prior pregnancies, eclampsia in prior pregnancies, or multiple pregnancies such as twins or triplets. The risk is also greatest in the first pregnancy, along with obesity, conception through in vitro fertilisation, and pre-existing conditions such as lupus, kidney disease or prior clotting disorders.
Dr Buchanan added that other conditions such as the development of HELLP syndrome may also result in eclampsia.
She explained that HELLP Syndrome is marked by anaemia, abnormal function of the liver, and a decrease in blood platelets. Low platelets predispose the woman to bleeding disorders and other complications such as liver rupture, bleeding into the liver, vaginal bleeding and bleeding behind the placenta. Kidney damage and foetal demise may also be seen in HELLP syndrome.
Other risks of eclampsia include maternal trauma, including head trauma, stroke, undigested food in the maternal stomach going to the lungs, which can lead to breathing problems, failure of maternal organs, maternal death, sudden foetal death, or premature delivery. Death is rare once medical treatment is started promptly. Within a few days or weeks, most women will fully recover from the complications, which include visual problems, stroke symptoms and kidney damage. Recovery from high blood pressure tends to occur approximately six weeks after birth, but a small percentage of women will remain hypertensive.
Dr Buchanan emphasised that early detection and urgent prenatal care will avert most cases of eclampsia.
“An anti-seizure medication called magnesium sulphate in the form of an injection can prevent seizures. It also helps to protect the foetal brain from brain damage, and in the case of premature babies, allows the medical team to more safely delay delivery for at least two days in order to give the foetus life-saving steroids that help the lungs to develop prior to delivery. Blood pressure medications will be used to control blood pressure levels.”
She stressed the importance of this process, since early delivery is the only way to definitively prevent most seizures. After delivery, preeclampsia starts to improve, and the risk of eclampsia is significantly lower.
She said that methods of prevention such as the use of aspirin, calcium and dietary modification (for example, a low salt diet) have also been explored in a number of studies, but no clear link has been identified, particularly because these conditions arise from genetic predispositions, defects in the placenta, along with other complex factors which science is still trying to elucidate.
While some cases of eclampsia are not preventable, Dr Buchanan said that the condition can be managed.
“With proper prenatal care, strict adherence to all prenatal visits, and close attention to the advice of your doctor/midwife, this can significantly help to decrease the risk of eclampsia. If eclampsia develops, delivery has to happen urgently to prevent further deterioration of both mother and foetus,” Dr Buchanan advised.
