General Practice 2022

Pré-eclâmpsia: what é, symptoms, treatment and complicationsções

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Pré-eclâmpsia: what é, symptoms, treatment and complicationsções
Pré-eclâmpsia: what é, symptoms, treatment and complicationsções

Preeclampsia is a serious complication of pregnancy that appears to occur due to problems in the development and attachment of placental blood vessels, leading to spasm of these vessels, changes in blood clotting ability, and decreased blood circulation.

Your symptoms can manifest during pregnancy, especially after the 20th week of pregnancy, at childbirth or after delivery and include high blood pressure, greater than 140 x 90 mmHg, presence of protein in the urine and swelling of the body due to fluid retention.

Some of the conditions that increase the risk of developing preeclampsia include when a woman becomes pregnant for the first time, is older than 35 or younger than 17, is diabetic, obese, is pregnant with twins, or has a history of kidney disease, hypertension or previous preeclampsia.

Main symptoms

The symptoms of preeclampsia can vary according to the type:

1. Mild preeclampsia

In mild preeclampsia, signs and symptoms usually include:

  • Blood pressure equal to 140 x 90 mmHg;
  • Presence of protein in urine;
  • Swelling and sudden weight gain, such as 2 to 3 kg in 1 or 2 days.

In the presence of at least one of the symptoms, the pregnant woman should go to the emergency room or hospital to measure blood pressure and do blood and urine tests, to see whether or not she has preeclampsia.

2. Severe preeclampsia

In severe preeclampsia, in addition to swelling and weight gain, other signs such as:

  • Blood pressure greater than 160 x 110 mmHg;
  • Severe and constant bilateral or frontal headache;
  • Pain in the right side of the abdomen;
  • Decrease in the amount of urine and the urge to urinate;
  • Changes in vision, such as blurred, dim or star-gazing sensation;
  • Burning sensation in the stomach.

If the pregnant woman has these symptoms, she should go to the hospital immediately.

Possible causes

Preeclampsia is caused by a problem with the development of blood vessels in the placenta, which become narrower, decreasing the ability of blood to flow properly and leading to changes in blood clotting.

Some factors can increase the risk of developing preeclampsia such as:

  • Family history of preeclampsia;
  • Preeclampsia in a previous pregnancy;
  • Fetal growth restriction;
  • First pregnancy;
  • Multiple pregnancy;
  • Pregnancy after age 35;
  • In vitro fertilization or other assisted reproduction;
  • History of placental abruption;
  • Diabetes mellitus;
  • Kidney diseases;
  • Chronic high blood pressure;
  • Obesity;
  • Lupus erythematosus;
  • Tendency to the appearance of thrombosis.

In addition, the time between pregnancies, with 10 years or more between one pregnancy and another, can increase the risk of developing preeclampsia.

How the treatment is done

The treatment of preeclampsia seeks to ensure the safety of the mother and baby, and tends to vary according to the severity of the disease and the length of gestation. In the case of mild preeclampsia, the obstetrician usually recommends that the woman stay at home and follow a low-s alt diet with increased water intake to about 2 to 3 liters a day.In addition, rest should be strictly followed and preferably on the left side, in order to increase blood circulation to the kidneys and uterus.

During treatment, it is important for the pregnant woman to control her blood pressure and perform routine urinalysis to prevent preeclampsia from getting worse. In some cases, the obstetrician may request that the pregnant woman keep a diary with three blood pressure measurements a day, and that she take this history with her every prenatal visit.

In the case of severe preeclampsia, treatment is usually done with hospitalization. The pregnant woman needs to be hospitalized to receive medications that will help prevent eclampsia and maintain pressure, such as magnesium sulfate. If a hypertensive peak occurs, antihypertensive drugs can be used directly in the vein, in addition to close monitoring of blood pressure, renal function, and neurological and fetal well-being.

The only definitive treatment for preeclampsia is induction of labor, a technique that is generally used in the most severe cases and when the baby has a chance of surviving alone or in the NICU.

Possible complications of preeclampsia

Some of the complications that preeclampsia can cause are:

  • Eclampsia: it is a more serious condition than pre-eclampsia, in which there are repeated episodes of convulsions, followed by coma, which can be fatal if not treated immediately. Learn how to identify and treat eclampsia;
  • HELLP Syndrome: another complication characterized by, in addition to the symptoms of eclampsia, the presence of destruction of blood cells, with anemia, hemoglobin levels below 10.5% and a drop in platelets below 100,000/mm3, in addition to elevated liver enzymes, with TGO above 70U/L. Learn more details about this syndrome;
  • Premature abruption of the placenta: happens when the placenta detaches from the wall of the uterus, before the baby is born, causing bleeding. This is an obstetric emergency, in which the baby must be delivered as soon as possible, by cesarean;
  • Bleeding: occur due to destruction and decrease in the number of platelets, and impairment of clotting ability;
  • Acute pulmonary edema: situation in which there is collection of fluid in the lungs;
  • Liver and kidney failure: which may even become irreversible;
  • Prematurity of the baby: a situation that, if severe and without the proper development of its organs, can leave sequelae and compromise its functions.

These complications can be avoided if the pregnant woman undergoes prenatal care during pregnancy, since the disease can be identified at the beginning and treatment can be done as soon as possible.

A woman who has had preeclampsia can become pregnant again, and it is important that prenatal care is performed rigorously, according to the obstetrician's guidelines.

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