Preeclampsia, occurs in the second half of pregnancy, namely after the 20th week, and causes symptoms such as increased blood pressure (over 140/90 mm/Hg), protein escape in the urine, and edema in the body, especially in the hands and face, and can have fatal consequences for both the mother and her baby. If it is not diagnosed early and not managed correctly, it can pose vital risks for both the baby. In fact, it has a rate of approximately 25 percent among the causes of maternal deaths worldwide. In other words, it can be said that preeclampsia is responsible for one-fourth of maternal deaths worldwide.
Since it was first described, that is, for about more than 100 years, preeclampsia has been known as a disease of theories and the underlying cause has not been fully determined. The information we have today is that in mothers who develop preeclampsia, the placenta does not develop like other healthy pregnancies (insufficient trophoblastic invasion). Since the placenta cannot settle into the uterine wall sufficiently, many harmful substances (free oxygen radicals) emerge in the placental bed, these harmful substances spread throughout the body via blood stream, causing damage to the inner layers of the vessels throughout the body. Damaged vessels throughout the body leak fluid out of the vessels, which causes edema in all organs and cavities (brain, lungs, rib cage, liver, abdominal cavity, hands, palms, face, etc.). Many problems can be seen in edema-affected organs, primarily dysfunctions and organ failures.
Due to inadequate placental invasion, the transmission of oxygen and other needs to the baby in the womb is weaker than in normal pregnancies, and this can cause developmental limitations, lack of oxygen, and fetal growth restriction, disabilities and death of the fetus.
As can be seen from the above, preeclampsia is one of the most serious diseases of pregnancy.
Preeclampsia is seen in approximately 2-7 of all pregnancies. The incidence can be roughly accepted as 5 percent. However, some groups have an increased risk for developing preeclampsia. These are:
Preeclampsia is seen more frequently in the groups described above than in the normal population.
Preeclampsia comes to mind in cases of hypertension (blood pressure higher than 140/90 mm/Hg), protein leakage in the urine, and edema that occur in the second half of pregnancy (may be earlier in multiple and molar pregnancies). On detailed examination, it is clarified that these problems occur in the second half of pregnancy and that they were not present up until that point.
For increased blood pressure, a 30 mm/hg increase in systolic blood pressure and a 15 mm/hg increase in diastolic blood pressure can be considered as increased blood pressure in pregnant women who know their blood pressure before pregnancy. However, it is also a reality that risks for both the mother and her baby are seen when diastolic blood pressure exceeds 90 mm/hg.
After the diagnosis of preeclampsia, further tests are needed. Examinations and questions are made to determine whether the brain (headache, vision problems or vomiting), lungs (shortness of breath, rapid breathing, signs of lack of oxygen, cyanosis), liver (pain in the liver area, vomiting), kidneys (protein leakage in the urine and decreased urine output: less than 500 ml in 24 hours) are affected, and tests are performed to determine whether there is liver and kidney damage or disseminated intravascular coagulation disorder.
Since the development of the baby in the womb may be negatively affected by inadequate placenta formation, the baby would also need to be evaluated. For this purpose, the fetus is evaluated with fetal ultrasonography. Fetal growth restriction (babies being small compared to their peers), whether there is a decrease in amniotic fluid, evaluation of arterial and venous blood flow in the umbilical cord and other parts of the baby with a doppler, and evaluation of blood flow in the vessels leading to the uterus with a doppler are also procedures that can be performed during the diagnosis of preeclampsia.
The only treatment for preeclampsia is delivery and removal of the placenta. Delivery is the best approach for both mother and baby in full-term pregnancies, meaning that the pregnancy has been completed. However, in pregnancies that have not yet reached full-term, delivery also brings with it the risks of premature birth, meaning prematurity, for the baby. Therefore, in cases of preterm preeclampsia, the timing of delivery will require a more detailed and comprehensive approach.
In order to help us with the diagnosis and treatment of patients, preeclampsia cases are also categorized. In cases diagnosed with preeclampsia, if the findings called severe preeclampsia symptoms develop, this is called "severe preeclampsia" and the decision to deliver is on the agenda. If there are no severe preeclampsia symptoms and the pregnancy has not yet reached term, then close monitoring is aimed for whether severe preeclampsia symptoms develop until term. If severe preeclampsia symptoms or signs develop during follow-up, it will again be necessary to make a decision to deliver.
Preeclampsia follow-up and treatment must be carried out in a fully equipped tertiary center under the supervision of a perinatology (high-risk pregnancy) specialist, where there are also specialists such as neonatologists, anesthesiologists, etc. who may be needed, and where there are intensive care conditions for the mother and baby.
Preventive medications are currently available for pregnant women who are at high risk of developing preeclampsia. Especially in the groups described above that are at high risk of developing preeclampsia, the use of acetylsalicylic acid starting from early pregnancy until late pregnancy (32-36 weeks) can reduce the risk of developing both preeclampsia and severe preeclampsia. Therefore, it would be beneficial for all women planning a pregnancy to visit a perinatologist and have their situation assessed during the planning phase before getting pregnant.
