Description of preeclampsia
Pre-eclampsia is a serious condition resulting in pregnancy. It occurs in about 4-8% of pregnancies. It is a condition characterized by elevated blood pressure (140/90’s borders), and protein in the urine (0.5 g / 24 hours). Need not be presentedema, as previously assumed. Edema present themselves without hypertension does not mean anything. A distinction is made between the many types and classifications of hypertensive disorders in pregnancy, there is some chaos. Important for the clinic is not limited to, whether it’s called. Preeclampsia superimposed, overlying a primary hypertension which has a worse prognosis. Or appeared to pregnancy. Usually becomes the twentieth week of pregnancy or later. Its cause lies in the so-called. Endothelial dysfunction mother. It means that a woman is not balanced for factors and anti-blood cells, blood vessels form more factors that induce vasoconstriction vasoconstriction. Another factor is the poor development of the placenta.
Eclampsia is a life-threatening condition, which typically sets to preeclampsia. But not always. There is also a form without prior preeclampsia, which is very important precisely because this diagnosis may not come in time. It is a seizure disorder manifested by tonic-clonic movements that occur without other brain pathology.
HELLP syndrome is defined laboratory markers: hemolytic anemia, elevation of liver enzymes, low platelet count.
Risk factors for preeclampsia
Risk factor is hypertension. May be primary or secondary. Primary (essential) hypertension is hypertension, where we find the cause. In secondary hypertension cause is known. That can be a renal disease, endocrine glands (adrenal, thyroid, ..) that when treating hypertension and disappears.
Hypertension has a number of risk factors, which therefore also applies to hypertensive disease of pregnancy. It obesity, excessive intake of salt, elevated blood lipids, smoking, and many others. In addition, pre-eclampsia have other risk factors. For example, preeclampsia occurs more inprimiparae is also important genetic predisposition, age pregnant before age 18 and above 35years. By the fetus are congenital malformations, multiple pregnancies, hydatidiform mole.
prevention of preeclampsia
Prevention Preeclampsia is a regular visit to the antenatal clinic. In early pregnancy, expectant mothers come around once every four weeks. Later shorter intervals, towards the end of pregnancy, women attending her obstetrician weekly. In counseling to mothers to measure the pressure and also examines urine, bring, if it contains protein. If so, the doctor must distinguish other possible disease characterized by high blood pressure and protein in the urine and deploy the appropriate treatment.Such pregnant women are then kept in the so-called. Risk counseling and visits to the obstetrician are then more frequent.
symptoms of preeclampsia
Preeclampsia is manifested as hypertension. What is important is the severity of hypertension. The first, and usually the only symptoms are headache, fatigue and nausea. These are early symptoms.Visual disturbances and other symptoms in late pregnancy do not see, because they are obviously treated. The greatest danger are changes in the placenta, which threaten the development of the fetus. May lead to its poor supply of oxygen and the subsequent development of retardation.
Eclampsia usually occurs in four stages. First prodromal phase is very short and sometimes completely absent. Usually pregnant restless, there is twitching of facial muscles, Eyeballs and bottling her head to the side, her strong headache. Characteristically epigastric pain – his ribs in the liver landscape. Then comes a phase of tonic seizures – mainly affects the neck and back muscles, if a pregnant woman is tight. It takes a few seconds. The phases clonic manifests generalized twitching of muscles throughout the body. This phase is the longest, the order takes minutes. This stage leads to coma with mydriasis (dilated pupils), reduced reflexes, deep breathing.
When Eclamptic seizure may not be done all phases. Sometimes occurs such as a sudden lapse into a coma – eclampsia, eclampsia sine (sine – without). According to the description it is evident that fit virtually indistinguishable from epilepsy. There is but one tool. Pregnant with eclampsia unlike epileptic usually not help, because there are so called. Anuria (kidney function are so reduced that it does not create enough urine).
treatment of preeclampsia
The main thing is to compensate for increased pressure. They are anti-hypertensives that are safe during pregnancy. It is, for example, α methyldopa, β-blockers, or calcium channel blockers. In pregnancy, except in exceptional indication should not be given ACE inhibitors and diuretics!It is important to treat pregnant ones who really need them. Ie. Not every increase pressure for the need to cut. Sometimes that unnecessarily reduce pressure worsens blood flow to the placenta and endanger the fetus. It is up to the doctor to assess the pros and cons of therapy for each patient individually. It must be every pregnant anticonvulsant – cure cramps. Most often, Magnesium sulphuricum or benzodiazepine.
Eclampsia is one of the indications for termination of pregnancy, irrespective of gestational age and maturity.
complications of preeclampsia
Preeclampsia complications are eclampsia, DIC, HELLP syndrome. About eclampsia has been dealt with. Disseminated intravascular coagulation (DIC) is a life-threatening condition. It disruption of hemostasis, which may occur as a result of various conditions such as sepsis, severe bleeding, separation of placenta, amniotic fluid embolism, and not least on the basis of eclampsia. Leads to pathological activation of intrinsic factor, which activates protrombogenní mechanisms. When the formation of thrombi in the microvasculature. This happens in the first stage, which usually does not do. Additionally, there will be depletion of platelets, coagulation factors and occurs gradually to uncontrolled bleeding. If you initiate timely treatment can cure the condition. It consumes large amounts of blood, heparin and other substances, but the sick are healed. Depending on the overall condition of pregnant women and at what stage DIC treatment began.
HELLP is an abbreviation hemolytic anemia, elevation of liver enzymes, low platelet count. It is a syndrome that may or may not be annealed to preeclampsia. Arises on a similar basis as preeclampsia. Usually occurs in the second or third trimester of pregnancy. In the Czech Republic every year gets about five cases per thousand births. The main symptom is epigastric pain, then there are nausea, vomiting, headache, hypertension, protein in the urine. The syndrome is treated like preeclampsia, according to other symptoms, then treatment adds.
Pregnancy with HELLP syndrome usually completed but not in such dramatic circumstances as eclampsia. Usually they can still catch corticosteroids for fetal lung maturation. The fetus can give birth naturally.
How do you help yourself
As mentioned eclampsia risk factor is hypertension. It is not entirely clear how to prevent the development of hypertension, but it is clear that you can at least reduce the likelihood of its occurrence of risk factors (see above).
When the diagnosis of preeclampsia is necessary to observe the regime prescribed by the doctor.Bothers to take regular medication. If in any doubt may be pregnant should consult your gynecologist.
Other names: HELLP syndrome, eclampsia, late gestosis, EPH syndrome