Preeclampsia, a multisystem, hypertensive disorder, often afflicts expectant mothers after 20 weeks of gestation. This disorder affects nearly 5 to 8% of all pregnancies worldwide. Preeclampsia is the third leading cause of both maternal and perinatal morbidity and mortality. Detection of early signs of preeclampsia during pregnancy and taking preventive measures is therefore imperative to manage the disease and avoid any adverse outcomes. This article is an overview of the risk factors, signs and symptoms to look out for, and the approach to diagnosis, all to facilitate early detection of preeclampsia.
What is pre-eclampsia?
Preeclampsia is a life-threatening blood pressure disorder that often occurs after the 20th week of pregnancy. Patients usually have hypertension and proteinuria, where high levels of protein pass through their urine. Preeclampsia is characterized by a vascular abnormality affecting the liver, kidneys, brain and cardiovascular system. This condition is dangerous for both the mother and the developing fetus. When left untreated, preeclampsia can progress to eclampsia or seizures and HELLP syndrome, a life-threatening variant involving hemolysis, elevated liver enzymes, and low platelet counts.
Identification of risk factors
Not all pregnancies are the same. It is standard practice in obstetrics to detect high blood pressure early in the first trimester. Maternal age greater than 40 or less than 18 years, with a medical history of chronic hypertension, preeclampsia, kidney disease, lupus (SLE), and type I and type II diabetes, indicates that the pregnancy is high risk. Women over 35 who are experiencing pregnancy for the first time and struggling with obesity are at a lower risk of preeclampsia.
High-risk patients are often candidates for prophylaxis, such as low-dose aspirin therapy, ideally starting between 12 and 16 weeks’ gestation.
Clinical warning signs and symptoms
It is often difficult to detect warning signs of preeclampsia in its early stages, as many of the signs and symptoms of the disease are identical to the normal symptoms of a healthy pregnancy. Even so, any of the following signs and symptoms are a good reason for an early evaluation:
Persistent and Severe Hypertension
Transient fluctuations in blood pressure are normal. Persistent readings above 140/90 mmHg on two occasions four or more hours apart define the clinical criteria of the disorder. Patients at high risk may benefit from home blood pressure monitoring to generate early elevated readings.
Neurological symptoms
Vasospasm and cerebral edema can lead to neurological symptoms. Patients should be evaluated immediately for any of the following:
- Unexplained headaches: that are not relieved by the usual pain relievers.
- Visual disturbances: blurred vision, photophobia or intolerance to light, and scotoma (seeing stars).
Epigastric or right upper quadrant pain
This is very often mistaken for heartburn or indigestion. However, upper abdominal pain in relation to the right upper quadrant and below the right rib cage can be one of the signs of preeclampsia in pregnancy. This indicates inflammation or stretching of the liver capsule and requires appropriate treatment.
Sudden Onset of Edema
Edema or swelling of the feet and ankles usually occurs later in the third trimester due to venous compression. However, rapid swelling of the face, hands, or feet during pregnancy, preeclampsia, should prompt referral to a health care provider. Edema that develops rapidly in pregnancy is a concern.
Diagnostic Evaluation and Clinical Presentation
Pre-eclampsia had a severe past criteriabut it is now known to develop without necessarily showing high levels of protein in the urine. Timely tests to diagnose preeclampsia can prompt medical intervention and avoid end-organ dysfunction.
Laboratory markers of preeclampsia
When clinical suspicion is high, health care providers use specific diagnostic tests:
- Urine protein/creatinine ratio: To ascertain protein levels.
- Serum creatinine: To assess kidney function.
- Liver function tests (ALT/AST): To monitor for elevated enzymes indicative of liver stress.
- Platelet count: To check for thrombocytopenia.
BP monitoring at home
Modern obstetric practice supports the provision of a home BP monitoring cuff. This allows the collection of longitudinal data. An increase in previously stable BP values, even below 140/90, may indicate the development of preeclampsia and requires close monitoring to ensure maternal and fetal safety.
Prevention and Management Approaches
Although there is no way to eliminate the risk of preeclampsia, early diagnosis can prompt the initiation of management strategies aimed at extending the pregnancy to a safer gestational age.
Low-dose aspirin therapy
Low-dose (81 mg daily) aspirin is strongly recommended for women with overt symptoms of preeclampsia during pregnancy. Starting this medicine after 12 weeks of pregnancy may reduce the risk of early-onset preeclampsia. Randomized controlled trials have shown a significant reduction in risk with the use of this treatment.
Lifestyle and Prenatal Vigilance
- Ongoing prenatal visits:
Pre-eclampsia is an often silent disorder and monitoring with regular blood pressure and urine protein levels at antenatal visits is essential.
Proper weight gain
Weight gain is normal in pregnancy, but sudden weight gain indicates edema and should be evaluated at the earliest.
Reducing stress
Although stress does not directly cause preeclampsia, the body’s response to stress increases blood pressure and can complicate early detection of preeclampsia.
Conclusion
Early detection of preeclampsia requires vigilance on the part of both the expectant mother and the health care provider. Increased awareness of high blood pressure in pregnancy, even when it’s subtle, can lead to a healthy birth experience.
