Pre-eclampsia

Pre-eclampsia is a condition that can only develop in pregnancy and its symptoms include: high blood pressure (hypertension); protein in the urine; swollen legs, ankles and fingers (oedema); headaches; nausea and vomiting; blurred or disturbed vision; abdominal pain; and excessive weight gain. It very rarely occurs before week 24 but can strike quickly and its severity ranges from slightly swollen ankles and a small rise in blood pressure to the "full blown" condition of dangerouslyhigh blood pressure and fits; this is known as eclampsia which is extremely rare.

RARE AND TREATABLE

Around 5% of women develop pre-eclampsia with their first pregnancy. It is much less common in subsequent pregnancies. However, if you have any of these conditions, you will be closely monitored by your doctor or midwife throughout your pregnancy. 1 out of every 200 pre-eclamptic patients will develop eclampsia if the pre-eclampsia is untreated. Treatment is delivery of the baby. Current methods of monitoring pregnant women make the onset eclampsia a very rare condition.

DOCTORS MONITOR PREGNANCY

As the cause of pre-eclampsia is not yet known, prevention cannot be guaranteed; doctors and midwives are familiar with the symptoms, so you should attend all your antenatal check-ups to ensure that your blood pressure is monitored and early signs of the condition are noticed. If you have high blood pressure before pregnancy, you may need to change your tablets in pregnancy. Your blood pressure will be checked every one in two weeks. Low doses of aspirin may be given to pregnant women after 12 to 14 weeks, as aspirin may reduce the severity of pre-eclampsia if it occurs.

TREATABLE

Mild pre-eclampsia shouldn't warrant a hospital stay, but your blood pressure will be more frequently monitored and your urine checked. Relaxation, rest, gentle exercise, and a nutritious diet are recommended. If you have a severe headache, blurred vision, or your baby isn't moving as usual, you will need close hospital supervision; if your blood pressure continues to rise, drugs may be used to control it. Severe pre-eclampsia means that your baby may be delivered early, often by a Caesarean, because of the risk of your having a seizure.

H.E.L.L.P.

HELLP syndrome, which is a unique variant of preeclampsia (toxemia), was named by Louis Weinstein in 1982 after its characteristics:

• H (hemolysis, which is the breaking down of red blood cells),
• EL (elevated liver enzymes), and
• LP (low platelet count).

HELLP Syndrome occurs in tandem with preeclampsia, but because HELLP Syndrome's symptoms may happen before preeclampsia's three findings (high blood pressure, protein in the urine, and swelling), they may be misdiagnosed as symptoms of gastritis, disseminated intravascular coagulation (DIC), acute hepatitis, gall bladder disease, and other conditions. If the diagnosis of preeclampsia was delayed a woman's likelihood of developing HELLP Syndrome would be higher. It can be fatal to both the mother and the baby. But this can be treated and prevented. The only definitive treatment is delivery, regardless of how far along the pregnancy is.

The physical symptoms of HELLP Syndrome may seem at first like other pregnancy-induced high blood pressure conditions (such as preeclampsia). Signs for a pregnant woman to look for include one or all of the following:

• Headache
• Nausea/vomiting
• Tenderness (stomach) and right upper quadrant pain (from liver distention)

These symptoms may or may not be present: severe headache, visual disturbances, bleeding, swelling, high blood pressure, protein in the urine.

BABIES BORN FROM H.E.L.L.P.

The good news is, in the majority of cases, the babies born to mothers with HELLP Syndrome do remarkably well. If the baby weighs over 1000 grams (approx. 2 lbs.), at birth, his or her survival rate and length of hospital stay is similar to non-HELLP babies of comparable sizes, and there doesn't seem to be many long-term adverse outcome. West Virginia University is studying long-term medical and developmental outcome of these babies.

If the baby weighs less than 1000 grams at delivery, the news is not so good. Several studies have suggested longer hospital stays and more chance of needing ventilator care.