Discuss the causes, risk factors, detection, treatment and complications?
Preeclampsia also referred as toxemia or pregnancy-induced hypertension (PIH), is a multisystem disorder which is characterized by de novo hypertension and proteinuria or superimposed maternal hypertension or nephropathy in pregnant woman (Kanasaki & Kalluri 2009), (Bell, 2010). This disease affects both the mother and the fetus usually beyond 20 weeks of gestational age. Although the reason behind this disease is not clear till date, but the disease is known to be recognized nearly 200 years ago (Kanasaki & Kalluri 2009), (Bell, 2010) Preeclampsia is known to affect 2-5% of pregnancies. The rate exceeds to an approximate of 10-18% in some developing countries. According to a study, UK is one of the leading countries affected with this disease. One out of twenty (5%) women suffers from severe pre-eclampsia or eclampsia causing significant number of maternal deaths in UK. (NICE Clinical guideline). Statistical data reveal that every minute, somewhere in the world death occurs during pregnancy or childbirth. This amount to an approximate of 1400 number of women death per day; more that 500,000 death every year. Additionally, maternal and fetus mortality is estimated to 13% worldwide in case of undetected preeclampsia (Scazzocchio & Figueras 2011), (Marik and Plante, 2008).
This multisystem disorder may be categorized into early-onset and late-onset preeclampsia. Early-onset preeclampsia shows fetal-growth restriction (FGR), abnormal uterine and umbilical artery. Doppler waveforms and adverse maternal and neonatal outcomes (Verlohren et al., 2014).Whereas, the late-onset preeclampsia is characterized with lower rate of maternal involvement and favorable perinatal outcomes. Abnormal placental implantation along with endothelial dysfunction is the main features of preeclampsia. Both the renal and vascular systems are affected altogether (Kanasaki & Kalluri 2009),(Karumanchi et al., 2005).
The exact cause of preeclampsia is unknown. Experts believe it begins in the placenta — the organ that nourishes the foetus throughout pregnancy. In women with preeclampsia, these blood vessels don’t seem to develop properly and limits the flow of blood (Redman, 2005), (Segers et al., 2007), (Karumanchi et al., 2005). Recent research show that the causative agent behind the pathogenesis of this disease is maternal endothelial dysfunction, which is mediated be the excess placenta derived soluble VEGF receptor 1 (sVEGFRI or Sflt1) (Venkatesha et al., 2006), (Luft, 2006), (Foidart et al.; 2010). Causes of this abnormal development may include:
Pre-eclampsia develops only as a complication of pregnancy. Risk factors include:
In the majority of cases, symptoms of preeclampsia aren’t noticeable. Women may experience headache, blurred vision, upper abdominal pain and unexplained anxiety. Serious cases of preeclampsia may result in seizures (Tuovinen et al.; 2010). Abnormalities of the liver, kidneys and blood clotting mechanisms may also be present. Dramatic weight gain, a decrease in urine output, blurry vision, nausea, and abdominal pain maybe reasons to watch more closely for the development of preeclampsia. (Sibai et al., 2005). Typically, preeclampsia occurs in the late 2nd or 3rd trimesters of pregnancy (Young, B.C. et al., 2010), (Tuovinen et al.; 2010), (Wood, 2013).
The only effective treatment for preeclampsia is delivery. Doctors will take into consideration gestation of the fetus in terms of development before inducing labor. If a woman has a good support system in her home, she can manage mild preeclampsia with bed rest and frequent visits to her obstetrical care provider. She may also need to monitor her blood pressure at home on a regular basis. Serious cases of preeclampsia may require admission to the hospital for more intensive monitoring of both the mother and unborn baby. If tests indicate that the health of either of the mother or fetus is at risk, an obstetrician may recommend inducing labor early or performing a caesarean section (Downing, 2010). A study by the Magpie Trial Collaborative Group in June of 2002 found that magnesium sulfate (MgSO4) can ease the symptoms of preeclampsia and has reduced seizures stemming from eclampsiaby56% when given intravenously in a controlled environment by trained staff (Tukur, 2009). Magnesium sulfate has been a standard treatment option in the U.S. since the1950s; however, it is not widely used internationally (Kenny, L.C. et al., 2010), (Tukur, 2009). For women at high risk of pre eclampsia may be detected by the application of ultrasound markers (Mace et al., 2012).
References
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