We’ve all heard the saying that when a woman gets pregnant, one of her feet is literally in the grave. I fully believed that when it came my turn to bear children, as both of my pregnancies almost ended up tragically. I had pre eclampsia on both occasions and my children were born before term. My eldest, Andie, was born at 30 weeks and 2 days. She was only 1.3 kilograms. The second one was able to reach 36 weeks, but only through constant monitoring and check ups.
Before I tell the rest of my story, let me first go over the medical or clinical definition of pre eclampsia.
What is Preeclampsia?
Preeclampsia is a medical condition that is characterized by an abnormally high amount of protein the urine of a pregnant woman and the sudden onset of high blood pressure to a pregnant woman, who prior to pregnancy had normal blood pressure. Yes, it is that kind of a traitor!
Preeclampsia used to be referred to in the medical circle as toxemia of pregnancy because of the mistaken belief that the condition was caused by toxins. If untreated, preeclampsia can develop into the life-threatening occurrence of seizures or eclampsia.
Preeclampsia is a very dangerous complication of pregnancy, affecting both the mother and the fetus. The condition may develop as early as the 20th week of gestation. There is early onset of preeclampsia, which is characterized by increased morbidity, if it occurs before the 32nd week of pregnancy, which is what happened to me. Preeclampsia does not always manifest early. It is always diagnosed before the beginning of labor. There are cases when preeclampsia occurs as late as six weeks after the mother had delivered the baby.
If left untreated, preeclampsia may lead to a very serious, oftentimes fatal, complications to both the mother and the baby.
What Happened to Me
I got pregnant with my first child at age 30. Although that may be considered late a couple of decades ago, I can brag that I was at the pink of health the time I conceived. I was exercising regularly and eating well-balanced meals. I come in for my prenatal check ups every month and take all my vitamins religiously. Even the oral glucose tolerance test given during my sixth month was clear – I was for all intents and purposes having a very normal and healthy pregnancy. I was gaining a lot of weight because of the pregnancy, but didn’t mind because I thought it was just normal. However, after the sixth month I started having more frequent headaches, was sweating more and was starting to become moon-faced because of edema. Everyone who saw me thought it was just normal, so I didn’t rush to my doctor until it was almost too late.
Early Signs Of Preeclampsia
Although medical practice considers only hypertension and proteinuria as the signs of preeclampsia, there are other signs that could possible point to the condition. Edema or swelling of the face and hands of the pregnant woman could be red flags to watch for when looking for the possibility of having preeclampsia. Edema could be a good indicator of preeclampsia if the swelling of the face, feet, and hands leave an indentation when pressed (pitting edema). Such occurrences must be immediately reported by the pregnant woman to health professionals.
Severe headaches, nausea or vomiting, dizziness, and changes in vision such as blurred vision, temporary loss of vision, and sensitivity to light may indicate preeclampsia in a pregnant woman.
Pregnant women should be watching their weight closely. They should see the doctor if there is a sudden weight gain, more than 2 pounds in a week, as this could be indicative of preeclampsia.
Another possible indicator that is oftentimes ignored is epigastric pain, or pain in the middle and upper parts of the abdomen. It could be indicative of preeclampsia but is always confused with heartburn which is a very common problem of pregnant women.
Convulsion in pregnant women could be an indication of preeclampsia but in most cases they are attributed to another condition.
Diagnosis of preeclampsia depends on the occurrence of several pre-eclamptic features. These pre-eclamptic features are expected to regress after delivery.
How It is Diagnosed?
Preeclampsia is typically asymptomatic. It will show only when the pregnant woman develops high blood pressure (140/90) and the occurrence of proteinuria (0.3 grams or more of protein in a 24-hour urine sample).
Severe preeclampsia occurs when the blood pressure of the pregnant woman rises to 160/110 and the protein in the urine tops 5 grams in the 24-hour urine sample. The condition is also characterized by manifestations of end organ damage (CNS) dysfunction which are manifested by symptoms such as severe headache, renal dysfunction with creatinine level over 1.5 mg/dl, hepatocellur injury with ALT more than twice the upper normal limit, hematologic dysfunction with a platelet count of less than 100,000/L or DIC, placental dysfunction with IUGR or oligohydramnios.
In my case, my condition was not diagnosed until it was severe. After attending my brother’s college graduation where I had to sit down for a long time, I noticed severe edema in my legs and hands. My blood pressure also started to shoot up and I was feeling dizzy and nauseated. During that time, my brother said my blood pressure was at 180/150. He was in such a state of panic that he was shaking when he was calling my OB. My husband was as pale as a ghost. By the time we saw my doctor, I was immediately admitted to the hospital and sedated. The lab tests showed that my blood sugar was three times above normal and my blood pressure was not dropping even after medication.
That Awful, Awful Mag Sulfate
My doctor warned us that if my condition does not get any better, she will have to operate on me and deliver the baby. She wanted some more tests to see how the baby was doing just to be sure. In the meantime, because of my incredibly high blood pressure she said I was prone to suffering from seizures. To prevent this, I was given eight doses of magnesium sulfate. Warning to any woman, this is the last thing that you would want to have injected on your body or passed through an IV. Since this is a metal, it burns through your veins and your body will feel like it is being set on fire. I do not exaggerate. I still have scars on the injections sites from the magnesium sulfate. I always tell myself that when my kids grow up and they treat me badly, I will tell them that I had metal running through my veins just to save them. That ought to make them behave, I think.
The signs and test results were not good. We were told that there would be an emergency C-section as soon as the doctor arrives. I was prepped in the labor room and given another sedative. This was really touch and go. At one point, my husband was told that he might have to choose just one person to save – either the Mom or the child. My arms were so swollen from the edema that they could not find a vein for the IV line. After six excruciating tries, the ER nurse was able to insert an IV. My baby girl on the other hand, fought for her life. She was injected with a surfactant to expand her lungs. She was so tiny and did not cry immediately. When she finally did, the whole room cheered: we were safe!
Leaving the Baby Behind
Having been born pre-term, we had to leave the baby behind at the hospital. My head was still reeling from the experience of delivering my baby almost 3 months too early. Looking back, there was practically nothing that the doctors could do except deliver the baby. After giving birth, my blood sugar returned back to normal and my blood pressure became stable. It was as if nothing happened. Up until this day I often wonder if my body was not built to handle pregnancies. I can work long hours and lift weights or be athletic when needed, but pregnancy seemed not to agree with me. My second baby was a more traumatic experience because we were under close monitoring by a perinatologist (he’s the OB for high risk pregnancies) since I was eight weeks pregnant. I was admitted to the hospital 3 separate times and given massive doses of that awful, awful magnesium sulfate just to keep my blood pressure down. The doctor just wanted the baby ( a boy named Santiago) to reach 2 or more kilograms in weight so that he would not have to stay in an incubator for extended periods.
Predictive Tests For Pre Eclampsia
There are currently several tests that can predict or quantify the risk of preeclampsia, such as:
- Placental protein 13 (PP13) – Low levels in the first trimester of pregnancy could be indicative of higher risk of preeclampsia in the later stages of pregnancy.
- Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT-1) levels during late first or second trimesters of pregnancy may predict the onset of preeclampsia with high sensitivity and specificity.
- Vascular endothelial growth factor (VEGF) may help in detecting the early-onset preeclampsia although it does not have sufficient statistical power to predict it.
- Checking for podocytes in the urine of pregnant women could indicate preeclampsia or pregnancy-induced hypertension (PIT), another serious complication of pregnancy.
What Are The Risk factors?
One of the dangerous things about this condition is that it affects 6-8 percent of pregnancies worldwide. The onset of preeclampsia is common during the late second trimester or third trimester. It usually occurs after the 32nd week of pregnancy. Preeclampsia may occur as early as 20 weeks especially for those who are pregnant for the first time. It may occur much later during the second pregnancy, but in my case it started rearing its ugly head at 16 weeks. I had to take Aldomet twice a day, which is one of the anti hypertensive medication that pregnant women could take.
Doctors say that pre-eclampsia is more common in women who become pregnant while having pre-existing conditions such as diabetes, hypertension, autoimmune diseases like lupus, and inherited thrombophilias such as Factor V Leiden, renal diseases, family history of preeclampsia, obese women, and those who have twins or multiple births. Preeclampsia will highly occur in women with preeclampsia in the previous pregnancy. So yes, I knew that my second pregnancy would be a medical challenge right from the start.
The risk of having preeclampsia is higher in pregnant women who are younger than 20 or older than 40. Prolonged interval between pregnancies seem to increase also the risk of preeclampsia.
Causes Of Preeclampsia
While my story makes it sound that preeclampsia took me by surprise, I was told that there are ways to prevent it. Pre eclampsia is mostly attributed to a shallowly implanted placenta which can become hypoxic or deficient in the amount of oxygen delivered. This will then lead to an immune reaction that makes the placenta secretes unregulated inflammatory mediators and acting on the vascular endothelium.
The shallow implantation of the placenta is believed to the response of the pregnant woman’s immune system to the presence of the placenta which may suggest the pregnant woman’s lack of immunological tolerance in pregnancy. The result will be an immune response against paternal antigens from the fetus and the placenta. Another school of thought is that the pregnant woman does not have enough receptors for the proteins in the placenta that down regulate the maternal immune system’s response to it. This idea is also consistent with evidences pointing to miscarriage being caused by immunologic disorder where the pregnant woman’s immune system destructively attacks the tissues of the developing child.
There exist a number of theories that try to explain why preeclampsia occurs in a number of pregnant women. Some of the conditions that may give rise to the condition include the following:
- Endothelial cell injury
- Immune rejection of the placenta
- Compromised placental perfusion
- Altered vascular reactivity
- Prostacyclin and thromboxane imbalance
- Decreased glomerular filtration rate with accompanying salt and water retention
- Reduction in intravascular volume
- Increased irritability of the central nervous system
- Disseminated intravascular coagulation
- Uterine muscle stretch or ischemia
- Vitamin deficiency
- Hughes syndrome
- Genetic factors
- Thyroid dysfunction – The onset of subclinical hypothyroidism during the early stages of pregnancy is believed to increase the risk of preeclampsia.
Complications Of Preeclampsia
This is a serious and dangerous condition that should not be taken lightly. The complications of preeclampsia include the following:
- Reduced flow of blood to the placenta – The arteries that carry blood to the placenta are adversely affected by preeclampsia, resulting to lack of blood flowing into the placenta. This will result in the baby getting less oxygen and fewer nutrients that may cause slow growth, low weight at birth, preterm birth, and breathing problems for the baby.
- Placental abruption – The placenta could separate from the inner wall of the uterus before delivery, resulting to heavy bleeding and possible damage to the placenta, conditions which are life-threatening for both the mother and the baby.
- HELLP syndrome – Hemolysis or the destruction of red blood cells, elevated liver enzymes, and low platelet count is a life-threatening condition for both the mother and the baby. This syndrome is very dangerous as it may occur before any sign or symptom of preeclampsia appears. The syndrome is manifested in nausea and vomiting, severe headache, and pain in the upper right side of the abdomen.
- Eclampsia – Eclampsia develops when preeclampsia is not controlled. The common symptoms of eclampsia are abdominal pain in the upper right part of the abdomen, severe headache, vision problems, decreased alertness and other changes in mental status. Eclampsia can cause permanent damage to the pregnant woman’s vital organs like the liver, kidney, and the brain. When untreated, eclampsia can result to coma, brain damage, and death to both the mother and the baby.
- Preeclampsia may increase the pregnant woman’s risk of having cardiovascular diseases in the future.
There is no known cure to preeclampsia other than immediate birth by Caesarean section or induction of labor. If the condition will occur too early in the pregnancy when delivery may not be an option, the pregnant woman and the fetus will be in a very challenging situation. If the doctor will decide to give time to the baby to mature until delivery will be less risky, he is putting both the mother and the baby at a great risk of serious complications.
Doctors normally prescribe medications to lower blood pressure of the pregnant woman until delivery. Corticosteroid medications are prescribed to improve liver and platelet functions which are aimed to prolong the pregnancy to a point where delivery is less risky for the baby. Anti-convulsive medications, such as magnesium sulfate, may also be administered if preeclampsia is severe as was in my case.
Bed rest is oftentimes recommended by doctors when there is a mild care of preeclampsia and the delivery date is still far away. Bed rest increases blood flow to the placenta, giving the baby time to mature. Bed rest also helps lower the blood pressure.
Last and most importantly, frequent consultation with the doctor will go a long way in taking care of a pregnant woman’s preeclampsia. Close monitoring could be the most important key in handling the condition. If you’re pregnant and you’re not feeling well, don’t be afraid to call or consult your doctor. What you think is “normal” may actually already be a symptom of something else. In this case, it is better to err on the side of caution. Not everyone is as lucky as my children and I. There are thousands of women who die because of this every year.
Eat healthy, rest well, sleep and take your doctor’s advice seriously.