Pregnancy poisoning, with its medical name preeclampsia, is a disease that occurs with the combination of high blood pressure seen after the 20th gestational week and protein leakage in the urine.
The cause of pregnancy poisoning is unknown. However; Factors such as being the first pregnancy of the patient, advanced age pregnancy, history of pregnancy poisoning in previous pregnancies, multiple pregnancy, obesity, chronic hypertension are risk factors that cause pregnancy poisoning.
High blood pressure, edema, constant headache, visual disturbances, pain in the upper abdomen, back and stomach pain and shortness of breath are among the signs of pregnancy poisoning.
What is pregnancy poisoning (Preeclampsia)?
Preeclampsia, popularly known as pregnancy poisoning, is a disease caused by the combination of high blood pressure seen after the 20th gestational week and protein leakage in the urine (proteinuria).
What are the symptoms of pregnancy poisoning (Preeclampsia)?
Symptoms of pregnancy poisoning include:
High blood pressure: In a woman who had normal blood pressure before, systolic 140 mmHg and/or diastolic 90 mmHg and higher blood pressure is detected after the 20th gestational week.
Edema: Due to protein loss, widespread edema is common in the body, especially in the legs. In pregnant women due to increased blood pressure and edema;
long severe headache,
Visual disturbances such as floaters, blurred vision, sensitivity to light,
pain in the upper part of the abdomen, back pain, stomach pain,
New onset shortness of breath
changes in mental status,
Blurring of consciousness may be observed.
What are the causes and risk factors of pregnancy poisoning (Preeclampsia)?
The exact cause of pregnancy poisoning is not known. However, contrary to the vascular changes that should occur during the mother's adaptation to pregnancy, the destruction of the vessels and the narrowing of the vessels due to the substances secreted secondary to this destruction and the resistance in the blood flow may cause pregnancy poisoning.
Secondary to vascular damage, renal vascular damage and protein leakage are observed in the urine. Again, due to vascular effects, it gives symptoms such as pulmonary edema, headache, blurred vision. In the fetus, growth retardation and oligohydramnios (decrease in the amount of water) may be observed due to increased blood flow resistance.
There are various risk factors, especially genetic predisposition, in the formation of this impaired mechanism.
Risk factors that can cause pregnancy poisoning include:
Being the first pregnancy of the patient: Although the exact reason is not known exactly, high sensitivity to antigens from the father is one of the accepted theories.
Being 40 years or older: Chronic diseases and additional risk factors may develop in advanced age pregnancies. For this reason, the possibility of pregnancy poisoning increases in pregnant women aged 40 years or older.
Experiencing preeclampsia, that is, pregnancy poisoning in a previous pregnancy: Patients who have had preeclampsia in their previous pregnancies are approximately eight times more likely to have preeclampsia compared to patients who have not had such a history before.
Obesity: The risk of pregnancy poisoning increases for every 5-7 kg increase in body surface measurement in patients with a body mass index of 25 and above before pregnancy.
Multiple pregnancies: An increase in the number of fetuses in the womb increases the risk of preeclampsia.
Moreover;
chronic hypertension,
Vascular and connective tissue disorders,
Chronic kidney diseases are also among the risk factors that can cause pregnancy poisoning.
In whom does pregnancy poisoning (Preeclampsia) usually occur?
Pregnancy poisoning can be observed especially in people with risk factors, but it can also be observed in pregnancies without risk factors, although it is rare. Pregnancy poisoning is observed in approximately 5% of pregnancies worldwide.
What complications does pregnancy poisoning (Preeclampsia) cause?
Vascular damage in pregnancy poisoning causes widespread changes by affecting all organs.
The earliest sign of pregnancy poisoning is changes in blood pressure. High blood pressure increases over time and reaches a level of 140/90 ≤. In addition, diffuse edema is observed due to increased vascular permeability. Again, headaches due to vascular changes are of the type that are severe and respond poorly to painkillers.
Depending on the vascular changes in the eye, visual disturbances, defined as flashes of light in the eye, or visual field damage may occur. An increase in reflexes is observed. When vascular damage and hypertension are combined, it can lead to seizures and paralysis in advanced events.
Pulmonary edema and decreased urine output are other complications of pregnancy poisoning.
Due to impaired fetal blood supply and resistance in the blood flow in the placental vessels, growth retardation and a decrease in the amount of amniotic fluid can be observed in the baby. However, if preeclampsia developed correctly at the end of pregnancy, these findings may not be observed. In rare cases and in the presence of severe preeclampsia, placental abruption (separation) is a rare condition that threatens the life of the baby.
How is pregnancy poisoning (Preeclampsia) diagnosed?
In the diagnosis of pregnancy poisoning, blood pressure (high blood pressure) is measured clinically. The blood pressure measured at systolic 140 mmHg and/or diastolic 90 mmHg and above is monitored.
In cases with clinical suspicion, detection of 300 mg or more protein in 24-hour urine protein confirms the diagnosis of pregnancy poisoning. In centers where measurements cannot be made, it can be considered as ++ positive protein detection in routine urinalysis.
Elevated serum creatinine level (values above 1.1 mg/dl) and elevated liver enzymes are also important in the diagnosis of pregnancy poisoning. In addition, a decrease in the number of clotting cells called 'platelets' due to vascular damage is observed. This is more intense in advanced/severe cases.
How is pregnancy poisoning (Preeclampsia) treated?
The primary goal in the treatment of pregnancy poisoning is to keep the blood pressure under control until the time to ensure the healthy delivery of the baby. Therefore, the mother is started on antihypertensive medication (medicines used to treat high blood pressure).
If there is a risk of premature birth, corticosteroid amelioration treatment is applied to ensure the lung development of the baby.
The baby should be monitored and closely monitored in terms of its development and health in the womb.
If there is no response to treatment or worsening of clinical findings, delivery should be planned after 34 weeks. If it is between 24 and 34 weeks of pregnancy, it should be decided according to the condition of the mother and baby. As a result, the final treatment of this disease is to terminate the pregnancy by intervening with childbirth.