As one of the leading causes of maternal mortality worldwide, pre-eclampsia does not distinguish between social status, and its causes are poorly understood. Hypertension higher than 140 mmHg systolic and 90 mmHg diastolic that occurs after the 20-week gestational period and ends post-partum is pregnancy induced. In the U.S., pre-eclampsia and eclampsia are responsible for over 17% of maternal deaths. Patients with pre-eclampsia present with proteinuria, visual disturbances, headaches, and edema. From the point of diagnosis, careful monitoring and management are required to preserve the health of the mother and fetus. As a condition that may be caused by the trophoblastic invasion of the spiral arterioles at the site of the placenta, pre-eclampsia can hinder fetal development. The mother is at risk of grandmal seizures, general organ malfunction due to impaired circulation, and severe neurological manifestations. The severity of this condition means that those working with pregnant women at a primary and secondary care level need to play a role in monitoring its emergence and managing it if it does occur.
The Latest ACOG Guidelines on Diagnosing Pre-eclampsia
The Committee on Practice Bulletins–Obstetrics of the American College of Obstetricians and Gynecologists (ACOG) has developed a practice bulletin on the diagnosis and management of pre-eclampsia and eclampsia. While Pregnancy Induced Hypertension (PIH) is present when a woman’s blood pressure rises above 140/90 mmHg after the 20-week period, there are stricter criteria for diagnosing severe pre-eclampsia that require careful monitoring. Systolic blood pressure of 160 mmHg or higher on one occasion or diastolic blood pressure of 110 mmHg or higher on two or more occasions can lead to a pre-eclampsia diagnosis.
Proteinuria of 5g or higher in a 24-hour urine sample or 3g or higher in two urine samples more than 4 hours apart can lead to a diagnosis. Women may experience cerebral or visual disturbances due to increased blood pressure. Some women present with epigastric or upper right quadrant pain, and a palpable liver. Due to poor uterine perfusion, restricted growth may become apparent when performing a dating scan. Edema is a symptom, but is not remarkable—this is due to many healthy women experiencing it, as well as those with pre-eclampsia.
Managing Pre-eclampsia to Strike the Balance Between Maternal and Fetal Health
Pre-eclampsia comes with severe consequences for the mother and the fetus. Part of pre-eclampsia’s pathophysiology is the poor uterine perfusion. In a normal pregnancy, the spiral arterioles supplying blood to the placenta have a normal lumen and rich blood supply. A woman with pre-eclampsia typically experiences 40% function, which in turn impacts fetal growth. The patient’s vascular system is severely impacted, which means she is susceptible to renal and liver failure. As pre-eclampsia has an impact on the basement membrane of the glomerular, it can affect future renal function. The most severe form of pre-eclampsia—Hemolysis Elevated Liver Enzymes and Lowered Platelets (HELLP)—can lead to excessive red blood cell breakdown and damage. Because of the risk factors for both mother and fetus, early delivery is often necessary in severe cases. Testing blood pressure, kidney function, platelet levels, and proteinuria can help physicians and healthcare professionals at all levels determine when the best time to deliver the fetus is.
Refreshing Your Knowledge to Prevent Preeclampsia
Because of the risk factors for both mother and fetus, early delivery is often necessary in severe cases. Testing blood pressure, kidney function, platelet levels, and proteinuria can help physicians and healthcare professionals at all levels determine when the best time to deliver the fetus is. As healthcare professionals at primary, secondary, and tertiary care level need to look for signs of pre-eclampsia in expectant mothers, it is necessary to continuously update your healthcare education to ensure you do not miss signs. Many of the symptoms associated with pre-eclampsia are not spectacular on their own, and must be accompanied by other clinical markers in order for a diagnosis to be made. Repeated learning and exposure to updated information can help enhance clinical practice. Learning about the following symptoms as part of your education and during practice can help you identify whether they require further testing to diagnose pre-eclampsia:
Epigastric/Upper right hand quadrant pain
While those not heading for a career in obstetrics may learn that edema is a sign of pre-eclampsia, their educators may not place emphasis on the fact that this is a non-spectacular symptom when presented alone. Similarly, disturbed vision can indicate gestational diabetes, and epigastric pain is a symptom can be a sign of obstetric choleostasis. Taking the time to educate yourself regarding the symptoms related to pre-eclampsia and other serious obstetric concerns can help you make a timely referral for further diagnostic testing.
Managing Pre-eclampsia Post-Partum
The management of pre-eclampsia and monitoring for the condition does not end during the gestational period. Pre-eclampsia can appear 48 hours after delivery, and some cases have emerged in the 6-week post-partum period. Around 80% of women who die from pre-eclampsia do so during the post-partum period. As such, continued monitoring of women with PIH is essential. Similarly, close monitoring of a woman with pre-eclampsia should not end following a successful delivery. With consistent and continued care, physicians and healthcare professionals can play a role in reducing the prevalence of pre-eclampsia deaths.
Guest post by freelance writer, Lisa Mair.