Are gestational hypertension and preeclampsia the same? The answer is no. Let us discuss about hypertension during pregnancy and preeclampsia – its causes, symptoms, complications, types, management and much more to understand the difference.
Hypertension and pregnancy
Hypertension or increased blood pressure in pregnant women may be classified as
- Chronic hypertension– essential or secondary high blood pressure before pregnancy
- Gestational hypertension/PIH (pregnancy induced hypertension)-transient hypertension of pregnancy/ chronic hypertension identified in the latter half of pregnancy.
- Preeclampsia, eclampsia
- Preeclampsia superimposed on chronic hypertension- Superimposed preeclampsia refers to women with chronic arterial hypertension (primary or secondary) who develop preeclampsia.
Preeclampsia
Preeclampsia is a pregnancy-specific disorder which involves widespread endothelial dysfunction and vasospasm. Although preeclampsia usually occurs after 20 weeks of gestation, it can also present as late as 4-6 weeks postpartum. Preeclampsia is clinically defined as new-onset hypertension and proteinuria, with or without severe features. It can lead to eclampsia (generalized convulsions). Preeclampsia is also known as toxemia.
Eclampsia refers to the development of seizures in women with pre-eclampsia. This article delves into the causes, signs & symptoms, types, complications, risk factors, epidemiology, diagnosis and management of preeclampsia in particular.
Preeclampsia- types
Preeclampsia is classified based on the onset as
- Early onset (placental)
- Late onset (maternal)
Epidemiology
- Preeclampsia affects 2-3% of pregnancies worldwide but prevalence vary (among different race groups and different countries).
- Preeclampsia is associated with more than 50,000 maternal deaths every year (worldwide).
- Prevalence is more in hispanic and black people.
- In the UK, preeclampsia is a leading cause of maternal death.
- Several studies show that the morbidity is high in developing countries.
Causes of preeclampsia
There is poor understanding of the link between etiological factors and preeclampsia.
Studies show that multiple factors together lead to
- Endothelial cell dysfunction
- Intravascular inflammation
- Syncytiotrophoblast stress
It is found that early onset preeclampsia occurs due to defective placentation leading to uteroplacental ischemia, whereas late onset preeclampsia occurs due to mismatch between the maternal perfusion and fetal placental demands.
Signs and symptoms related to preeclampsia
- Severe headache
- Visual disturbances
- Epigastric pain
- Vomiting/nausea
- Shortness of breath
- Severe swelling of hands, feet, face or legs
Risk factors of preeclampsia
The risk of developing preeclampsia is higher in women with
- Chronic kidney disease
- Autoimmune diseases
- Nutritional deficiencies
- Type 1 or type 2 diabetes mellitus
- Chronic hypertension (pre existing)
- History of hypertensive disorders in previous pregnancies (risk of hypertensive disorders in future pregnancies)
- Family history of preeclampsia
- Interval between pregnancies( >10 years)
- Hydatidiform mole
- Multiple pregnancies
- Nulliparity
- AGE (> 35 years)
- Obesity (BMI >35)
- Assisted reproduction
- Fetal macrosomia
- Short stature
Pathophysiology of preeclampsia
Type I preeclampsia (placental) may present earlier. Placental dysfunction or malperfusion accompanied by other manifestations are the characterizations of type 1 preeclampsia. Type I is more often accompanied by fetal growth restriction (FGR). Low placental growth factor levels have a measurable effect on maternal cardiac remodeling and function.
Type II preeclampsia typically occurs in the later stages of pregnancy. Type 2 preeclampsia (maternal) involves an evolving maternal cardiovascular intolerance to the demands of pregnancy along with a moderately dysfunctional placenta and inadequate blood supply.
Investigations and diagnosis
- Patient history
- Vital signs including blood pressure
Evaluate blood pressure readings which include 2 measurements at least 4 hours apart.
- Urinalysis for proteinuria and blood analysis (coagulation profile and liver function test)
- Pulmonary examination
- Fetal ultrasound
- Umbilical artery doppler
- Physical examination for epigastric tenderness and edema.
Complications of preeclampsia
- Eclampsia
- HELLP syndrome
- Organ damage
- Cardiovascular diseases
- Fetal growth restrictions
- Placental abruption
- Preterm birth
- Fetal or maternal death
Management of preeclampsia
The only cure for preeclampsia is to deliver the baby (elective delivery) depending on the severity and fetal development. Medical management may control blood pressure and prevent further complications. Severe hypertension may develop near delivery and in such cases the patient must be hospitalized in order to take rest. The patient must be hospitalized if preeclampsia is suspected anytime during the pregnancy. Early detection of preeclampsia symptoms and causes must be done for effective management and prevention of complications. Patient counselling related to preeclampsia symptoms, risk factors, complications, management etc. will help the pregnant mother and the by-stander understand the disease and the importance of management. The management of preeclampsia include the following
1. Reducing blood pressure
Set a target DBP of 90-100 mm Hg. Choice of drug is important as some anti hypertensives may affect the fetus and the mother.
2. Seizure prophylaxis
Drugs are prescribed for preventing seizure in severe preeclampsia.
3. Antenatal corticosteroids
Maybe given in cases of severe preeclampsia to prevent respiratory distress in premature babies.
Written by Auxi Arobana. R