Edited by Eugenio Ciuccetti, Obstetrician
Generality
That of preeclampsia is still one of the main fears that accompany many pregnant women.
Diagnostic Criteria
Preeclampsia is characterized precisely by the simultaneous appearance, in the second half of pregnancy, of these three pathological aspects:
- On the one hand a pressure increase equal to or greater than 140mmHg for systolic and 90mmHg for diastolic.
- On the other hand, an increase in proteins equal to or greater than 0.3 grams in 1000 milliliters of urine.
- Finally, the significant formation of edema, or water retention, at various levels of the pregnant woman's body: from the legs to the hands, the face and the trunk.
Gestosis affects about 5% of pregnant women. But without forgetting that a woman can also be hypertensive before becoming pregnant and therefore run a 25% increased risk of developing pre-eclampsia during pregnancy. Then, out of all the preeclamptics, one in 200 develops a true form of eclampsia.
To learn more: Symptoms Pre-eclampsia
Complications
In fact, we speak of Symptomatic Gestosis as long as the fundamental symptoms described so far but without significant subjective manifestations are present. Instead, the so-called Eclampsia Imminente is passed when some characteristic subjective symptoms appear such as headache, visual disturbances (for example scotomas) and abdominal discomforts such as epigastric "bar" pain.
Finally, in the rarest and most serious cases, there is the actual eclamptic attack or Convulsive Eclampsia: when we are faced with authentic epileptic attacks followed by a loss of consciousness. Convulsive eclampsia can also lead to maternal death.
Causes
The causes of this syndrome are still today the object of study as its etiopathogenesis is a subject of debate and deepening. Certainly both the placenta and some of its important alterations are involved, probably linked primarily to genetic and hereditary factors. Just as there is no doubt that these are the basis of a complex pathological vicious circle - which can be activated at various levels and characterized by innumerable predisposing and adjuvant factors - which seriously jeopardizes both the well-being of the mother and that of the unborn child.
Going further into detail there are those who focus on endothelial dysfunctions caused by an altered balance between vasodilatory substances such as nitrogen oxide and vasoconstrictor substances such as Angiotensin II. Others observe that, in some women, the trophoblast (precursor of the placenta) is not able to invade the decidua correctly and erode the maternal vessels to create that physiological low resistance circle that normally allows the exchange of oxygen and nutrients between the mother and the fetus. In these cases barriers to these exchanges are formed and the placental circle is compromised.
Risks for the mother and the fetus
Because of the placental changes, thrombotic events are produced, with infarct and ischemic areas that in the worst cases can lead to the feared placental detachment.
In any case, it will result in a high resistance circle with negative consequences for the fetus that will receive little blood and will face problems of underdevelopment or even endouterine death.
Concerning the mother, the problems related to hypertension increase at the same time. Indeed, from the thrombotic and ischemic areas described above, vasoactive substances such as cytokines are released, which in turn cause vasoconstriction. This results in possible vascular damage and loss of vasoregulation, up to the risk of hemorrhage and brain damage. Such mechanisms can then kidney. Altering functionality at the glomerular level. Hence loss of protein with urine (especially albumin and globulin from damaged capillaries).
This increased excretion of proteins then lowers the colloidosmotic pressure and this - combined with the lower blood flow due to hypertension - justifies the consequent decrease in volume (ie circulating blood). We will therefore have the passage of liquids in the interstitium and problems of edema and ascites, in addition to a significant increase in overall body weight due to salt and water retention.
We could go on and on - citing for example the consequences that this syndrome can also have on the liver, platelets and coagulation system - and each of these points alone deserves further study. In this context, however, we only want to highlight the complexity of the problem and its various articulations, still not completely clarified today.
Risk factors
Regarding the risk factors of gestosis it is worth remembering the nulliparity, the multiple pregnancy, the familiarity, an abnormal diet, with excess sodium in the diet, the lack of other minerals such as calcium and magnesium, an increase in insulinemia and free fatty acids. Without forgetting the real predisposing diseases such as diabetes and obesity, the antiphospholipid antibody syndrome, kidney pathologies and naturally hypertension.
Treatment
Finally, the same therapeutic approach to preeclampsia will inevitably be based on different criteria and strategies. On the one hand we will have to intervene on the symptoms (such as hypertension) and prevent them from getting worse. The woman will have to stay at rest. You will be given hypotensive and other drugs, such as Magnesium Sulfate, which can prevent eclamptic seizures. Maternal and fetal well-being must be constantly monitored (blood pressure, liquid balance, blood chemistry, cardiotocographic tracing, ultrasound, etc.).
But the most delicate decision will certainly concern the timing of the birth. Its rapid completion could represent an effective solution. However, we must first carefully consider all the pros and cons of such a decision: from the real gravity and urgency of the situation, to the gestational age, until the relative development of the fetus (with the possible prophylaxis for lung maturation).
Preeclampsia - Drugs for the care of Gestosi »
