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Pre-eclampsia (PE) is a complication of gestation characterized by NEW emerging hypertension and proteinuria (protein - urine albumin) in a pregnancy after the 20th week of gestation.

How common is it?
Pre-eclampsia affects about 6-8% of pregnant women.

What causes pre-eclampsia?
Pre-eclampsia is thought to be caused by the placenta not developing properly due to a problem with the blood vessels supplying it, resulting in a reduced blood flow to the placenta and a sequence of events involved in the pathogenesis of pre-eclampsia.

How is pre-eclampsia diagnosed?
To diagnose pre-eclampsia, systolic blood pressure should be ≥140 mmHg and / or diastolic ≥ 90 mmHg plus proteinuria (albuminuria)> 300 mg / 24 hours after week 20 of gestation. Pressure measurements should be performed with a 4-6-hour distance between them.

When does pre-eclampsia occur during pregnancy?
In 99% of cases, pre-eclampsia occurs after the first half of the pregnancy. In most women the findings are evident after the 34th week of pregnancy. Around 10% of women, show signs of hypertension and albuminuria before the 34th week of pregnancy and around 5% of women at the postpartum period usually within the first 48h postpartum.

What are the risk factors for PE emergence?

• More frequent for a woman's first pregnancy (excluding miscarriages).
• Pre-existing renal disease (7 times more likely for PE to coexist with renal disease).
• Pre-existing hypertension.
• Systemic erythematosus lupus (increases the relative risk by 5.7 times).
• Women with pre–existing diabetes mellitus identified before or after the pregnancy are 3.6 times more burdened when they suffer from pre-eclampsia.
• The multiple pregnancy.
• A family history of PE in first-degree relatives.
• The mother’s age is >40 and maybe (not specified) and <17 years of age.
• Maternal obesity.

What are the signs of pre-eclampsia?

• Arterial hypertension, evident after 2 measurements performed with a 4-6-hour distance between them. More often it is gradually increasing.
• The first manifestation of pre-eclampsia can often be the rapid increase in body weight (in 1-2 days for over 1-2 kg/week).
• Persistent and severe headache. It is often described as the worst headache that has been experienced and is stiff (like a tightening sensation on the head) and is NOT reduced by common analgesics.
• Sudden swelling (swelling) in the legs and face.
• Patients often have severe stomach pain or abdominal pain in the right upper quadrant.
• Vomiting, but not the normal morning sickness at the beginning of the pregnancy, but later after week 20 of pregnancy.
• Visual disturbances: blurred vision, blindness (dark areas in the field of vision)

Can we predict the appearance of preeclampsia?
There is no diagnostic method that can predict the occurrence of preeclampsia. That is why it is very important to assess the potential risk factors and for the pregnant woman to be set under an early pregnancy monitoring protocol. Both gynecologists and nephrologists are experienced and familiar with such incidents, so they are detected very early, treated with the best possible care leading in a successful pregnancy outcome.

How is preeclampsia treated?

• Treating preeclampsia depends on the maternal age and on the severity of the disease.
• If preeclampsia occurs at the final stage of pregnancy, then the delivery will terminate the pre-eclampsia.
• If preeclampsia doesn’t occur at the final stage of pregnancy, then the maternal age and the severity of the disease are the ones that will determine how pre-eclampsia will be coped with. There are medicines that can safely and adequately control the blood pressure of the mother and the fetus. -If there are no other pre-eclampsia complications, the pregnancy may progress with a normal hypertension control. But if pre-eclampsia leads to a serious illness, then the delivery is necessary to protect the mother and the fetus.

Having preeclampsia in a first pregnancy increases the risk of developing it again in a second or subsequent pregnancy?

• If there is no evidence or pre-eclampsia during the first pregnancy, then the probability of occurrence in the second pregnancy is small.
• There is a small chance for women who have had mild preeclampsia during a full-term pregnancy to suffer from pre-eclampsia in the next pregnancy.
• In contrast, women with severe pre-eclampsia with a baby delivery before the 30th week of pregnancy, are very likely to show signs of preeclampsia in future pregnancies.

Conclusions
Preeclampsia is an unpleasant condition and constitutes a serious complication in pregnancy. Hence, we must remain calm and identify in cooperation with our doctor the possible risk factors for its appearance in the first few weeks of the pregnancy. A pregnancy monitoring plan should be developed along with your gynecologist and the nephrologist.

The purpose is to closely monitor and record:

• the blood pressure,
• the body weight,
• the albuminuria levels,
• the embryonic development (with frequent ultrasound scanning)

so that if the pregnancy progresses with pre-eclampsia, all the necessary steps must be taken to ensure to a safe delivery.

Mesogeios Dialysis Centers Group Scientific Team 

Bibliography
1: Valdés G. Preeclampsia and cardiovascular disease: interconnected paths that enable detection of the subclinical stages of obstetric and cardiovascular diseases. Integr Blood Press Control. 2017 Aug 28;10:17-23. doi:10.2147/IBPC.S138383. eCollection 2017. Review. PubMed PMID: 28894390; PubMe Central PMCID: PMC5584914.
2: Henderson JT, Thompson JH, Burda BU, Cantor A, Beil T, Whitlock EP. Screening for Preeclampsia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017 Apr. Available from http://www.ncbi.nlm.nih.gov/books/NBK447462/PubMed PMID: 28813128.
3: Amaral LM, Wallace K, Owens M, LaMarca B. Pathophysiology and Current Clinical Management of Preeclampsia. Curr Hypertens Rep. 2017 Aug;19(8):61. doi:10.1007/s11906-017-0757-7. Review. PubMed PMID: 28689331.
4: Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: Obstetric and Anaesthesia Management. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):125-138. doi:10.1016/j.bpa.2016.12.002. Epub 2016 Dec 18. Review. PubMed PMID: 28625300.
5: Luger RK, Arnold JJ. Pregnancy, Hypertension. 2017 May 3. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-. Available from http://www.ncbi.nlm.nih.gov/books/NBK430839/PubMed PMID: 28613589.
6: Lateef A, Petri M. Systemic Lupus Erythematosus and Pregnancy. Rheum Dis Clin North Am. 2017 May;43(2):215-226. doi: 10.1016/j.rdc.2016.12.009. Epub 2017 Mar 14. Review. PubMed PMID: 28390564.
7: Smyth A, Ronco C, Garovic VD. Preeclampsia: a Cardiorenal Syndrome in Pregnancy. Curr Hypertens Rep. 2017 Feb;19(2):15. doi: 10.1007/s11906-017-0714-5.Review. PubMed PMID: 28233241.
8: Naderi S, Tsai SA, Khandelwal A. Hypertensive Disorders of Pregnancy. Curr Atheroscler Rep. 2017 Mar;19(3):15. doi: 10.1007/s11883-017-0648-z. Review.PubMed PMID: 28229431.
9: Dhariwal NK, Lynde GC. Update in the Management of Patients with Preeclampsia. Anesthesiol Clin. 2017 Mar;35(1):95-106. doi: 10.1016/j.anclin.2016.09.009. Epub 2016 Dec 12. Review. PubMed PMID: 28131123.
10: Cuffe JSM, Holland O, Salomon C, Rice GE, Perkins AV. Review: Placental derived biomarkers of pregnancy disorders. Placenta. 2017 Jun;54:104-110. doi:10.1016/j.placenta.2017.01.119. Epub 2017 Jan 16. Review. PubMed PMID: 28117143