Preeclampsia and Eclampsia

Preeclampsia usually affects pregnant women with no history of high blood pressure, sometime after the 20th week of pregnancy. The ICD defines it as: "A condition affecting pregnant females over 20 weeks gestation. This condition is characterized by systolic blood pressure (the upper number) greater than 140mmHg and diastolic greater or equal to 90mmHg on two occasions 4 hours apart in the presence of either proteinuria (protein in urine) or other new onset maternal organ dysfunction characterized by one thrombocytopenia (low platelet count), elevated serum creatinine or liver transaminases (a liver enzyme), or neurological conditions or fetal growth restriction in a female diagnosed with pre-existing hypertension."

Preeclampsia can be early-onset or late-onset. Here are the different types of preeclampsia:

• Early-onset preeclampsia is defined as preeclampsia that starts after the 20th week and before the 34th week of pregnancy. Since a foetus is considered viable only after the 24th week of pregnancy, this may require slightly different management than late-onset preeclampsia.
• Late-onset preeclampsia is preeclampsia that starts during or after the 34th week of gestation.
• Severe preeclampsia is a condition in which the systolic blood pressure (the pressure in the blood vessels when the heart pumps blood through them) goes over 160 mm of Hg or the diastolic blood pressure (the pressure on the blood vessels in-between heartbeats) goes over 110 mm of Hg. (Read more: How to measure blood pressure)

Preeclampsia superimposed on chronic hypertension

This is a slightly different blood pressure problem during pregnancy. Here, the pregnant woman already has high blood pressure before the 20th week of pregnancy. What is new is:

• Proteinuria
• A drop in platelet count, to less than 100,000 platelets per cubic millimetre of blood (the normal range is 150,000-400,000 platelets per cubic millimetre)
• There could also be a sudden rise in blood pressure or protein in urine in this condition

Preeclampsia is a disorder in which pregnant women—often with no history of hypertension—develop high blood pressure. It is important to remember that preeclampsia is different from gestational hypertension, which may occur for a number of reasons as the volume of blood in the expecting mom's body increases to support the baby.

In preeclampsia, the increase in blood pressure usually occurs after the 20th week of pregnancy—there have been cases of postpartum preeclampsia also.

In preeclampsia, high BP is accompanied by protein in the urine (proteinuria) and/or organ damage (especially in the liver, kidneys or lungs).

The key symptoms of preeclampsia are:

• High blood pressure: Blood pressure is measured in millimetres of mercury or mm Hg. In preeclampsia, pregnant women develop blood pressure over 140/90 mmHg (the normal blood pressure range is 90/60 mmHg to 120/80 mmHg). In severe preeclampsia, blood pressure rises over 160/110 mmHg. To diagnose preeclampsia, your doctor will need to take at least two BP readings more than four hours apart.
• Severe headaches during pregnancy
• Eye problems like blurry vision or even loss of vision for a short duration
• Nausea and vomiting
• Abdominal pain during pregnancy, especially in the upper right side of the stomach
• Less urination during pregnancy
• Shortness of breath

In terms of signs that would be visible through tests, doctors would see one or more of these signs:

• Protein in the urine (proteinuria): Until recently, doctors did not give a diagnosis of preeclampsia in the absence of this symptom. However, this thinking has changed of late. Though still an important marker, increased protein in the urine (more than 5 grams in a 24-hour sample or more than 3 grams in two samples taken at an interval of six hours) is not seen in some cases of this hypertensive disorder during pregnancy.

Preeclampsia in India

In 2019, medical researchers Ankita Malika and Satish Kumar Gupta of the National Institute of Immunology, Delhi, and Babban Jeeb of the Union health ministry collaborated to present important data on the incidence of preeclampsia in the country.

According to their research, published as "Preeclampsia: Disease biology and burden, its management strategies with reference to India" in the peer-reviewed journal Pregnancy Hypertension:

• Preeclampsia and eclampsia are seven times more common in developing countries than in developed nations.
• Preeclampsia-eclampsia is the second most common "direct cause of maternal mortality" after haemorrhaging or bleeding.
• Blood pressure problems during pregnancy, including preeclampsia, are responsible for 7-8% pregnancy-related deaths in India.
• Blood pressure problems, especially preeclampsia, is a major cause of preterm births in India.

While a mild case of preeclampsia can be managed with bed rest and medicines and all signs tend to go away within weeks after delivery, more serious cases can have lasting effects on the health of the mom and baby:

After delivery, women who have preeclampsia during pregnancy may develop blood and heart diseases like:

• Chronic high blood pressure
• Ischemic heart disease
• Stroke

In children who are born of preeclamptic pregnancies, some of the following problems may be seen:

• Intrauterine growth restriction (IUGR): Researchers have found evidence that the blood vessels that supply blood to the placenta don't develop or work properly in a preeclamptic pregnancy. This means that the foetus may not get adequate oxygen and/or nutrition during gestation. Sometimes this can be seen as small size for gestational age (SGA)—the foetus appears smaller than he or she should be for that stage of pregnancy. Preeclamptic pregnancies could necessitate emergency or scheduled Cesarean section. They could also lead to preterm birth and low birth weight—less than 2.5 kilograms at birth.
• Risk of heart disease and metabolic disorders: Children born of preeclamptic pregnancy are also at higher risk of stroke, coronary heart disease or metabolic syndrome later in life.