Ensuring a safe pregnancy
10 January 2022
WHEN a woman is expecting, the health of both mum and baby is of utmost priority.
However there are situations that can put both at risk. This includes a condition known as preeclampsia and its' even rarer progression, eclampsia.
Sunway Medical Centre Velocity (SMCV) consultant obstetrician and gynaecologist, Dr Nor Elyana Noordin says preeclampsia is a pregnancy complication characterised by high blood pressure and signs of damage to another organ system, most often the kidneys where it leaks protein (proteinuria).
This is caused by the abnormal formation of blood vessels in the placenta and the mother's blood vessels. What causes the abnormalities, however, remains unknown.
"Eclampsia is the onset of fits or seizures in pregnant women and is a severe complication of preeclampsia. Preeclampsia mostly occurs during the antenatal period, more so in the third trimester."
Statistically speaking, the prevalence of preeclampsia and eclampsia is 4.6 per cent and 0.3 per cent respectively, elaborates Dr Elyana.
In Malaysia, eclampsia made up 6 per cent of maternal deaths in 2020, taking the fourth spot along with ectopic pregnancies, and ranked after obstetric embolism, postpartum haemorrhage and gestational hypertension with significant proteinuria.
Pregnant women need to be carefully monitored.
WARNING SIGNS
According to Dr Elyana, eclampsia can be prevented with proper treatments administered at the right time, and regular check-ups since there are signs and clinical parameters that can help predict severe preeclampsia.
Pregnant ladies with preeclampsia have to be monitored closely through regular blood pressure monitoring, serial blood investigations and urine protein tests to ensure the wellbeing of both mother and baby.
If blood pressure is uncontrolled even with optimal medications, or there are abnormal blood parameters, the baby has to be delivered so that preeclampsia does not worsen and progress to eclampsia.
Although preeclampsia sometimes develops without any symptoms, incidences of high blood pressure should be picked up during antenatal check-ups.
Other signs that may be present during severe preeclampsia are severe headaches, vision problems, pain below the ribs, severe nausea and vomiting, sudden weight gain and swelling (oedema) in the face and hands.
Having diabetes, high blood pressure or kidney disease before becoming pregnant can increase one's risk of developing preeclampsia, as well as having conditions such as lupus or antiphospholipid syndrome.
Other instances that can slightly increase the chances of preeclampsia include first time pregnancies, a family history of the condition, being over 40 years old, having a 10-year gap from the last pregnancy, expecting multiple babies (twins or triplets) or a Body Mass Index (BMI) of 35 or over.
SMCV consultant obstetrician and gynaecologist, Dr Wong Yen Shi, shares that there is a 15 per cent chance of a woman developing preeclampsia in her second pregnancy if she experienced it in her first.
Dr Wong says there are lifestyle factors that can help reduce the chances of preeclampsia.
"It is important to ensure that blood pressure is under control prior to embarking on a pregnancy journey for ladies with underlying hypertension. Aspirin is used to prevent or delay the onset of preeclampsia."
Exercising and a well-balanced diet is also important for general well-being but it does not prevent preeclampsia, she adds.
Dr Wong explains that the most effective treatment of preeclampsia would be delivery of the baby, but if it is pre-term, management of the condition includes antihypertensive medications, blood or urine tests and regular follow-ups to monitor both the mother and foetus.
"If the pregnancy has reached 37 weeks or more, delivery may be warranted via induction of labour or caesarean section. For mothers who have not reached 37 weeks but have developed preeclampsia complications, they would need immediate delivery."
With the condition originating from the placenta, preeclampsia may prevent the baby from obtaining sufficient blood supply – as a result, the baby may be smaller in size as it does not grow at a normal rate inside the womb, also known as foetal growth restriction.
Preeclampsia and its complications increase the likelihood of preterm delivery. The complications that follow preterm deliveries may include cerebral palsy (irreversible movement disorder), learning disabilities, feeding or gut problems, as well as visual or hearing impairment, says Dr Wong.
While every pregnancy and delivery is different, the best way to prevent complications from preeclampsia, and subsequently eclampsia is early diagnosis. Prenatal and postnatal care is key. Patients must go for consistent check-ups and share any new symptoms that arise so that they can be managed quickly for a safe delivery.
Patients must go for consistent check-ups and share any new symptoms that arise.
