By Dr Ajay Phadke
Pregnancy complications are not unheard of during childbirth. One such is Preeclampsia, a common but highly ignored pregnancy complication, which puts not just the mother, but also the baby at risk. Preeclampsia alters blood flow from the mother to the placenta, resulting in an insufficient supply of oxygen and nutrients to the baby inside the womb. It usually reveals itself after the 20th week of pregnancy, and sometimes even in the postpartum phase.
Preeclampsia is characterised by elevated blood pressure and high levels of protein in the urine. Women with preeclampsia have also complained of sudden weight gain, severe headaches, visual disturbances, upper abdominal pain, or excessive swelling in face, hands, feet and legs. But these can be, and are often misdiagnosed as side-effects of pregnancy.
“Preeclampsia found in 8-10 per cent of pregnant Indian women”
The condition remains under tested in the first trimester of pregnancy. In the second trimester, clinicians rely on high BP and proteins in urine to make an initial diagnosis. A research published by the National Health Portal of India in 2016, confirms that preeclampsia is found in 8-10 per cent of pregnant Indian women. The condition is a precursor to other life-threatening conditions like eclampsia and HELLP Syndrome, in which case the only solution is preterm delivery of the baby (before the 32nd week of pregnancy).
Eclampsia includes all the symptoms of preeclampsia, while additionally making the condition worse with the onset of seizures. HELLP Syndrome, on the other hand, can cause liver rupture, kidney failure, placental abruption (detachment of the placenta from the uterus before birth) and pulmonary edema (fluid in the lungs). In some cases, HELLP syndrome can also cause stroke.
According to a 2018 research paper presented by Government Medical College in Amritsar, Punjab, about 4-12 per cent women diagnosed with severe preeclampsia will develop HELLP syndrome.
Who is at risk of preeclampsia?
Women with Type 1 or Type 2 diabetes, chronic hypertension, kidney diseases and/or family history of preeclampsia are primarily prone to the condition. Other established risk factors include late conception like pregnancy at 40 years (or above), or an interval in pregnancy of more than 10 years. Preeclampsia may also show up in a twin pregnancy, but it is more common in first time pregnancies.
There is evidence that preeclampsia can also have genetic predisposition, either due to the mother’s genetics or the genetics of the baby. It is, therefore, essential for all expecting mothers to get screened for the condition in the first trimester of their pregnancy. Preeclampsia, if it goes undiagnosed, can have serious implications on maternal health like ante-partum hemorrhage, postpartum hemorrhage, acute renal failure and stillbirths, in rare cases.
What are the tests for preeclampsia?
Essentially, there are two tests:
The first test is a screening called Preeclampsia Screen, performed in the first trimester of pregnancy, between 11 – 13.6 weeks. The test uses three markers for Risk Stratification of developing preeclampsia later in pregnancy:
- Serum Biomarkers (PAPP-A, Free beta HCG and PLGF),
- Biophysical markers (MAP- Mean Arterial Pressure & UAPI-Uterine artery Pulsatility index) and
- Maternal History
This test helps reveal, women who could be at high rate of preeclampsia later on in pregnancy.
The second test, Preeclampsia Ratio, is to diagnose preeclampsia in women with high blood pressure after 20th week of pregnancy. The test uses a ratio of two biomarkers. If the ratio is high, prompt delivery is advised.
Both these tests are important in preventing serious complications in the mother and child’s health. A meta-analysis performed recently shows that a low dose aspirin up to 150mg/day, if started before Week 16 of gestation can cause a significant reduction in the risk of preeclampsia and IUGR (intra uterine growth restriction) in women. Preeclampsia is identifiable and curable with the help of such lab test developments.
The unfortunate irony though, is that despite continuous efforts being taken by medical professionals to predict future health complications, the idea of implementing precautionary measures is not being emphasised enough. Due to this lack of push, the condition most often than not goes unidentified, misdiagnosed or detected too late. There is, thus, a dire need to drive awareness.
Motherhood is the most precious phase in a woman’s life. To-be-mothers often feel that changes in the body are indicators of a new beginning. This common notion leads to ignoring signs of life threatening pregnancy complications. Let ignorance not drive you to compromise on the best of your health and that of your baby.
(The writer is the Centre Head of SRL Dr Avinash Phadke Path Labs, Mumbai.)