Preeclampsia

Overview:

In preeclampsia, fetal circulation is compromised due to maternal hypertension and placental dysfunction, leading to reduced blood flow to the placenta. The impaired placental blood flow results in less oxygen and nutrients being delivered to the fetus, which can cause intrauterine growth restriction (IUGR) and increase the risk of preterm birth. This can further affect the fetal circulatory system, potentially leading to abnormal closure of fetal shunts after birth, such as the ductus arteriosus or foramen ovale. Consequently, preeclamptic pregnancies can lead to complications like persistent pulmonary hypertension in the newborn (PPHN) and require close monitoring after delivery to manage these cardiovascular risks effectively.

1. Definition: 

Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of

damage to another organ system, often the kidneys. Preeclampsia usually begins after 20 weeks

of pregnancy in a woman whose bloodpressure had been normal. Even a slight rise in blood

pressure may be a sign of preeclampsia. Left untreated, pre-eclampsia can lead to serious — even

fatal — complications for both you and your baby. If you have preeclampsia, the only cure is delivery

of your baby. If you're diagnosed with preeclampsia too early in your pregnancy to deliver your baby,

you and your doctor face a challenging task. Your baby needs more time to mature, but you need to

avoid putting yourself or your baby at risk of serious complications. 

2. Symptoms: 

Preeclampsia sometimes develops without any symptoms. High blood pressure may develop slowly, but more commonly it has a sudden onset. Monitoring your blood pressure is an important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood pressure. 

3. Complications: 

The more severe your preeclampsia and the earlier it occurs in your pregnancy, the greater the risks for you and your baby. Preeclampsia may require induced labor and delivery. Surgical delivery (cesarean section or C-section) isn't always advantageous unless other problems are present, such as a baby in breech presentation, or if a speedy delivery is necessary. If you have severe preeclampsia or you're at less than 30 week’s gestation, a C-section may be necessary. 

Complications of preeclampsia may include: 

• Lack of blood flow to the placenta. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, your baby may receive less oxygen and fewer nutrients. This can lead to slow growth, low birth weight or preterm birth. Prematurity can lead to breathing problems for the baby. 

• Placental abruption. Preeclampsia increases your risk of placental abruption, in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding and damage to the placenta, which can be life-threatening for both you and your baby. 

• HELLP syndrome. HELLP — which stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count — syndrome can rapidly become life-threatening for both you and your baby. Symptoms of HELLP syndrome include nausea and vomiting, headache, and upper right abdominal pain. HELLP syndrome is particularly dangerous because it represents damage to several organ systems. On occasion, it may develop suddenly, even before high blood pressure is detected. 

• Eclampsia. When preeclampsia isn't controlled, eclampsia — which is essentially preeclampsia plus seizures — can develop. Symptoms that suggest imminent eclampsia include upper right abdominal pain, severe headache, vision problems and change in mental status, such as decreased alertness. Because eclampsia can have serious consequences for both mom and baby, delivery becomes necessary, regardless of how far along the pregnancy is. 

• Cardiovascular disease. Having preeclampsia may increase your risk of future heart and blood vessel (cardiovascular) disease. The risk is even greater if you've had preeclampsia more than once or you've had a preterm delivery. To minimize this risk, after delivery try to maintain your ideal weight, eat a variety of fruits and vegetables, exercise regularly, and don't smoke. 

4. Treatment: 

The only cure for preeclampsia is delivery. You're at increased risk of seizures, placental abruption, stroke and possibly severe bleeding until your blood pressure decreases. Of course, if it's too early in your pregnancy, delivery may not be the best thing for your baby. 

a. Medications: 

Possible treatment for preeclampsia may include: 

• Medications to lower blood pressure. These medications, called antihypertensives, are used to lower your blood pressure if it's dangerously high. Blood pressure in the 140/90 millimeters of mercury (mm Hg) range generally isn't treated. Although there are many different types of antihypertensive medications, a number of them aren't safe to use during pregnancy. Discuss with your doctor whether you need to use an antihypertensive medicine in your situation to control your blood pressure. 

• Corticosteroids. If you have severe preeclampsia or HELLP syndrome, corticosteroid medications can temporarily improve liver and platelet function to help prolong your pregnancy. Corticosteroids can also help your baby's lungs become more mature in as little as 48 hours — an important step in preparing a premature baby for life outside the womb. 

• Anticonvulsant medications. If your preeclampsia is severe, your doctor may prescribe an anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure. 

d. Delivery: 

If you're diagnosed with preeclampsia near the end of your pregnancy, your doctor may recommend inducing labor right away. The readiness of your cervix — whether it's beginning to open (dilate), thin (efface) and soften (ripen) — also may be a factor in determining whether or when labor will be induced. 

In severe cases, it may not be possible to consider your baby's gestational age or the readiness of your cervix. If it's not possible to wait, your doctor may induce labor or schedule a C-section right away. During delivery, you may be given magnesium sulfate intravenously to prevent seizures. 

Why is preeclapsia important to the RT?: 

Preeclampsia holds significant importance for neonatal respiratory therapists as it can directly impact the respiratory health of newborns. Infants born to mothers with preeclampsia may face complications such as preterm birth, low birth weight, and respiratory distress syndrome (RDS). These babies often require specialized respiratory care and interventions to support their lung development and function. Preeclampsia can lead to premature delivery, increasing the risk of neonatal respiratory issues due to underdeveloped lungs. Neonatal respiratory therapists play a crucial role in providing respiratory support to these infants, including administering surfactant therapy, assisting with mechanical ventilation, and closely monitoring their respiratory status to mitigate the consequences of preeclampsia on neonatal respiratory health.