Definition

Preeclampsia is a condition characterized by increased blood pressure with protein in the urine that occurs in pregnant women over 20 weeks gestation. This can affect other organs and is dangerous for both mother and fetus.

Preeclampsia occurs when the blood pressure above 20 weeks of pregnancy is more than 140/90 mmHg and high levels of protein are found in the urine. This condition is one of the four types of hypertension in pregnancy. The other three conditions are:

• Gestational hypertension, which is high blood pressure that appears after 20 weeks of gestation but no protein is found in the urine
• Chronic hypertension, which is hypertension or high blood pressure that started before pregnancy
• Chronic hypertension with superimposed preeclampsia, which is a worsening of chronic hypertension and causes more protein in the urine and other complications

Preeclampsia is a serious condition that needs to be treated immediately. It can affect blood intake to the placenta as well as cause damage to various organs such as the liver, kidneys, and fluid buildup in the lungs.

Like high blood pressure, preeclampsia is closely related to race and ethnicity. However, preeclampsia is one of the most common causes of preterm labor in the world and one of the most common causes of maternal death in Indonesia.

In preeclampsia, termination or delivery is recommended as therapy. However, it all depends on the patient's condition and gestational age. In some cases, preeclampsia may also appear after the baby is born.

Causes

The cause of preeclampsia is still unknown. However, problems with the placenta are still the cause that experts and scientists believe. The placenta, which is supposed to provide oxygen and nutrients to the fetus, is disrupted, leading to increased blood pressure and various complications.

Other suspected causes, such as stress, have not been shown to be associated with preeclampsia. Some potential causes of preeclampsia include genetic factors, vascular conditions, and autoimmune diseases.

Risk Factor

Preeclampsia is more common in the first pregnancy. In addition, some of the factors below may increase the risk of preeclampsia, such as:

• History of hypertension
• African ethnicity
• Kidney disorders
• History of diabetes before pregnancy
• Twin pregnancy
• Age under 18 years old or over 40 years old
• IVF pregnancy
• Previous history of preeclampsia
• Family history of preeclampsia
• Presence of autoimmune diseases such as lupus erythematosus
• Presence of sleep disorders 
• History of obesity

Symptoms

Symptoms of preeclampsia vary from asymptomatic to severe. Early symptoms of preeclampsia are high blood pressure, protein in the urine, and swelling of the legs. 

Other symptoms of preeclampsia include:

• Headaches
• Blurry vision or light sensitivity
• Dark spots appearing in your vision
• Right side abdominal pain
• Swelling in your hands and face (edema)
• Shortness of breath

It is important to share and tell the examining doctor your true condition. Many patients do not realize they have preeclampsia until they go for blood and urine tests at a routine pregnancy consultation.

Severe preeclampsia may include symptoms like:

• Hypertensive emergency (blood pressure is 160/110 mmHg or higher)
• Decreased kidney or liver function
• Fluid in the lungs
• Low blood platelet levels (thrombocytopenia)
• Decreased urine production

Diagnosis

The diagnosis of preeclampsia includes a history-taking process or interview between the doctor and the patient, a physical examination, and a supporting examination.

The doctor will conduct a question-and-answer session by asking the patient's main complaints, accompanying complaints, pregnancy history, lifestyle and daily activity history, history of previous illnesses, medical history, and family history of illness.

Followed by a physical examination, a physical examination is performed by assessing the patient's general condition by checking blood pressure, body temperature, pulse, and respiratory rate. Then the doctor will perform a physical examination to see if there is swelling of the limbs, abdominal pain, blurred vision, and other symptoms.

Next, the doctor will perform a supporting examination. Important supporting examinations to be carried out are urine tests to see protein levels in the urine, blood laboratory tests to see platelet levels, ultrasound, and if necessary, the doctor will conduct a non-stress test (NST) and fetal biophysical examination to see the health and well-being of the fetus.

Management

The management of preeclampsia depends on the severity and gestational age. When the pregnancy is close to full term (37 weeks), delivery is recommended. The recommended method of delivery will usually be via cesarean section. 

In addition, some medications may be given if the pregnancy is not full term. Doctors may give antihypertensive drugs to lower blood pressure, anticonvulsants to prevent seizures, and corticosteroid drugs to mature lung function.

After delivery, you and your baby will be closely monitored. You should ensure that you have no symptoms such as visual field changes, nausea, vomiting, seizures, headache, and abdominal pain before returning home.

Complications

Complications of preeclampsia may include:

• Seizures and progression to eclampsia
• Heart failure
• Blindness
• Hemorrhage after delivery
• Stroke
• Re-experiencing preeclampsia in subsequent pregnancies
• HELLP syndrome is a group of symptoms including destruction of red blood cells, elevated liver enzymes, and low platelet levels. This can lead to liver damage and is associated with the blood clotting process.

Prevention

So far, there is no specific prevention of preeclampsia. However, you can reduce the risk of pregnancy complications by doing the following:

• Conducting regular pregnancy check-ups
• Meet the nutritional needs of the mother and baby with a balanced nutritional diet according to the guidelines and recommendations of obstetricians
• Avoid stress
• Reduce salt and sugar intake
• Drink plenty of water every day
• Rest on the left side of the body
• Get enough sleep
• Avoid excessive caffeine consumption (more than 200 mg per day)

When to See A Doctor?

Immediately go to the nearest hospital if you experience the following conditions:

• Seizures
• Shortness of breath
• Severe pain in the right abdomen
• Blurred vision
• Severe headache
• Dark spots in the visual field that do not go away
• If you have a history of high blood pressure before pregnancy or experience any of the risk factors for preeclampsia, consult your obstetrician regularly.

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