(Pre)eclampsia [pregnancy-induced hypertension] is the third most important cause of maternal mortality worldwide. Hypertensive disorders of pregnancy may start after 20 weeks gestation, but they are more common toward the end of pregnancy.The symptoms may aggravate during the first postpartum days and occasionally the first symptoms are only recognized post partum. The most serious complication is intracerebral haemorrhage. A woman suffering from eclampsia or severe preeclampsia the first days post partum should be hospitalized.The symptoms of preeclampsia last until 3 to 7 days after the baby is born.
The main tasks of the caregiver who attends the postpartum period is to measure and record blood pressure after delivery, to swiftly identify symptoms that could be indicative of preeclampsia (headache, visual disturbances, epigastric pain), to protect the woman from damage during fits, and to arrange transport to a hospital or referral centre in case of a serious rise of blood pressure combined with these symptoms.While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium and kidneys and liver, with the release of vasopressive factors only secondary to the original damage.
The only cure for preeclampsia is delivery of the baby. If preeclampsia develops near the end of your pregnancy, delivery is the obvious solution. If you're diagnosed with preeclampsia earlier in your pregnancy, you and your doctor face the delicate task of prolonging your pregnancy to allow your baby more time to mature, without putting you or your baby at risk of serious complications.Prolonging pregnancies has been shown to result in maternal complications, as well as infant death in approximately 87% of cases. Pregnancies between 24 and 34 weeks gestation present a "gray zone," and the medical team and the parents may decide to attempt to delay delivery in order to allow the fetus to mature.
Preeclampsia is more common in a woman's first pregnancy and in women whose mothers or sisters had preeclampsia. The risk of preeclampsia is higher in women carrying multiple babies, in teenage mothers and in women older than age 40.The risk of preeclampsia is generally lower in second pregnancies than in first pregnancies, but not if the mother has a new partner for the second pregnancy. One explanation is that the risk is reduced with repeated maternal exposure and adaptation to specific antigens from the same partner. However, the difference in risk might instead be explained by the interval between births. A longer interbirth interval may be associated with both a change of partner and a higher risk of preeclampsia.
Among black women with pregnancy shown the higher rates of the hypertension condition known as preeclampsia among black women and indicate future risk for cardiovascular disease.Preeclampsia affects an estimated 3 to 5 percent of U.S. pregnancies. The onset of the disorder is detected by an increase in blood pressure and can cause protein in the urine — a sign of potential kidney damage and severe water retention resulting in swelling in the hands and feet. The condition can also affect circulation in the small vessels of the brain and the liver, causing headaches, double vision or abdominal pain. Preeclampsia can endanger the lives of mothers and babies, and is a common reason for premature birth.
Pregnant women who suffer the dangerous high blood pressure condition preeclampsia, or who deliver a low-birth-weight baby, may be at increased risk of developing kidney disease later in their lives.It may be that preeclampsia and renal disease are caused by similar mechanisms, or that preeclampsia directly causes or aggravates underlying renal disease.
In developing countries eclampsia is estimated to occur in about 1 in 100-1700 deliveries (Crowther 1985). In Europe and other developed countries, where the incidence decreased in this century, eclampsia is now estimated to occur around 1 in 2000 deliveries (Douglas & Redman 1992). A substantial part of cases of eclampsia occur in the first days post partum. Pritchard (1975) reported 28 of 154 (18%), and Lubarsky et al (1994) 97 of 334 (29%). Eclampsia occurring more than 48 hours post partum has traditionally been considered as exceptional but a recent study (Lubarsky et al 1994) reports that more than 50% of their postpartum cases initially presented 3 or more days postpartum. Apparently regional differences in the incidence and manifestation of eclampsia exist.
The disorder often comes on quickly, and there's no good way to know for sure which women will develop the condition. However, researchers from the National Institute of Child Health and Human Development recently announced that they have had success detecting those at risk of preeclampsia earlier in pregnancy by testing for high blood levels of certain proteins. In the future, doctors may be able to use such a test to diagnose preeclampsia at an even earlier stage.
Your health care provider will measure your blood pressure and test your urine at each prenatal checkup. Certain blood tests are required to confirm that you have the condition. In cases where these initial tests indicate the possibility of preeclampsia, more blood tests may be needed.
Urine testing for kidney cells can help detect preeclampsia, a potentially serious condition involving high blood pressure and fluid retention during pregnancy, according to findings published in the American Journal of Obstetrics and Gynecology.
In the new study, Dr. Vesna D. Garovic, of the Mayo Clinic, Rochester, Minnesota, and colleagues examined whether podocyturia, the term for the presence of certain kidney cells in the urine, can identify pregnant women with preeclampsia.
Podocyturia was present in all patients with preeclampsia. Compared with healthy women, those with preeclampsia showed significantly greater podocyturia.
Moreover, podocyturia was a better predictor of preeclampsia than any of the blood tests the researchers examined.
Further studies are needed, however, to determine exactly why greater numbers of kidney cells are released into the urine of women with preeclampsia, the team notes.
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