What is Pre- eclampsia?

Pre-eclampsia or preeclampsia is a medical condition characterized by high blood pressure(over 140/90) and significant amounts of protein in the urine and swelling(Edema) in the face, hands, thighs and legs in a pregnant woman. If left untreated, it can develop into eclampsia, the life-threatening occurrence of seizures during pregnancy.

There are many different causes for the condition. It appears likely that there are substances from the placenta that can cause endothelial dysfunction in the maternal blood vessels of susceptible women. While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium, kidneys, and liver, with the release of vasoconstrictive factors being a consequence of the original damage.

Pre-eclampsia may develop from 20 weeks’ gestation (it is considered early onset before 32 weeks, which is associated with an increased morbidity). Its progress differs among Patients; most cases are diagnosed before labor typically would begin. Pre-eclampsia may also occur up to six weeks after delivery. Apart from Cesarean section and induction of labor (and therefore delivery of the placenta), there is no known cure. It is the most common of the dangerous pregnancy complications; it may affect both the mother and fetus. It always resolves within a few days to weeks after delivery of the baby, and ultimately almost all mothers and babies do well.

It is unknown why some pregnant women develop pre-eclampsia, although some factors make development of the disease more likely (such as first pregnancy, family history of pre-eclampsia, pre-existing high blood pressure, multiple pregnancy). So far there is no test that will predict who will get the disease, and so far there is no way to prevent it.

• How does pre-eclampsia cause these problems?
• Does pre-eclampsia affect the baby?
• What is the treatment for pre-eclampsia?
• Why does my relative need to go to Intensive Care?
• What Happens in Intensive Care?
• How long will the Patient remain in Intensive Care?
• Weblinks
• Publishing Information

How does pre-eclampsia cause these problems?

In Pre- eclampsia, the main cause for the symptoms such as swelling, high blood pressure, reduced blood flow to major organs such as the kidneys. liver and brain is the constriction of the muscle tissue around the small arteries. Th red blood cells(Haemoglobin) attempt to squeeze through the constrictions, causing the symptoms, including the swelling, as fluids leak out into the tissues.

Does pre-eclampsia affect the baby?

The relative deficiency in the blood supply from the mother to the placenta limits the baby’s supply of nutrients and oxygen, which may lead to reduced growth of the baby (intrauterine growth restriction) and even oxygen deprivation. Therefore, once Pre Eclampsia is present, close monitoring of fetal welfare(heartbeat and regular ultrasounds) is important to ensure such problems do not become serious. The timing of delivery in cases of Pre Eclampsia which arise early in the second half of pregnancy can be particularly difficult, because a very premature fetus may be severely affected by Pre Eclampsia, but on the other hand, cannot be certain of survival outside the womb either. Sometimes Pre-mature delivery is necessary if the Baby’s life is in danger.

What is the treatment for pre-eclampsia?

The only known treatments for eclampsia or advancing pre-eclampsia are abortion or delivery, either by labor induction or Cesarean section. However, post-partum pre-eclampsia may occur up to six weeks following delivery even if symptoms were not present during the pregnancy. Post-partum pre-eclampsia is dangerous to the health of the mother since she may ignore or dismiss symptoms as simple post-delivery headaches and edema. Hypertension(high blood pressure) needs to be controlled with anti-hypertensive medication as continued high blood pressure can cause a stroke.

Antihypertensives(medication for high blood pressure) may reduce maternal and fetal mortality among pregnancy Patients with hypertension(High blood pressure).

Labetolol or Nifedipine(both blood pressure drugs) are often the antihypertensives(medication for high blood pressure) of choice for eclampsia or pre-eclampsia, especially Labetolol as it has little placental transfer.

The target blood pressure has been proposed to be 140-160 mmHg systolic and 90-105 mmHg diastolic.

In some cases, women with pre-eclampsia or eclampsia can be stabilized temporarily with magnesium sulfate intravenously to prevent seizures while steroid injections are administered to promote fetal lung maturation. To prevent seizures, Diazepam(Valium) or Phenytoine can be given as well. When induced delivery needs to take place before 37 weeks gestation, it is accepted that there are additional risks to the baby from premature birth that will require additional monitoring and care.

Why does my loved one need to go to Intensive Care?

Usually intravenous therapy or treatment with Magnesium and Antihypertensives(blood pressure medication) requires close monitoring. Furthermore, if a mother has developed kidney failure or if the swelling has caused fluids to move into the lungs, it is much safer to be in Intensive Care.

What Happens in Intensive Care?

• Your loved one will require monitoring using a Bedside Monitors and an Arterial Catheter(Arterial Line) where your loved ones Blood pressure is closely and constantly monitored
• Very close nursing and medical observation of neurological activities in order to prevent seizures
• You can expect your loved one to have frequent Chest X-rays and blood tests(Blood& Pathology tests in Intensive Care) especially monitoring of kidney and liver function, as well as Platelet count, Haemolysis and arterial blood gases (ABGs)
• Initially oxygen and respiratory support might be commenced via an oxygen mask or via Non- Invasive Ventilation(NIV) or BIPAP ventilation
• Infusion pumps are administering drugs to support your loved ones blood pressure and haemodynamic system, as well as intravenous fluids may be administered via a central venous catheter/ CVC(Central Venous Lines)
• If your loved one develops respiratory(breathing) difficulties, full ventilation using a Ventilators(Breathing Machine) and a Breathing Tube (endotracheal tube) may be required to improve and maintain the oxygen delivery, but is uncommon in Pre-eclampsia

How long will the Patient remain in Intensive Care?

A mother will generally leave the Intensive Care and go to the post-natal ward when she no longer requires the magnesium infusion (1-2 days after the delivery) and the raised blood pressure is easily controlled with tablets.

Weblinks

• PEARLS Pre Eclampsia Website
• Professional Women and Pregnancy

Any Questions?

Of course, if you have any questions or concerns, please discuss them with the ICU nurses and doctors.

All Intensive Care interventions and procedures carry a degree of potential risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for your loved one.

The information contained in this sheet is general in nature and therefore cannot reflect individual patient variation. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. INTENSIVE CARE HOTLINE attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the Disclaimer.

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