Mamas on Bedrest: An Update on Pre-Eclampsia

November 26th, 2012

Pre-Eclampsia is one of the leading reasons that mamas are prescribed bed rest. Overall, hypertensive disorders (high blood pressure) during pregnancy account for 11% of pregnancy related deaths during pregnancy according to the US Centers for Disease Control and Prevention. Clearly, early recognition and treatment of pre-eclampsia are essential for the health and well being of both mamas and babies. Here, we give a review of pre-eclampsia and some of the latest information and treatments available.

Overview

Definition-Pre-Eclampsia is defined as blood pressure > 140/90 mmHg on at least 2 occasions 6 hours apart and protein in the urine (>300mg in a 24 hr period). Pre-Eclampsia is also associated with facial and extremity swelling and in severe cases, kidney failure and grand mal seizures.

Presentation-Pre-Clampsia typically presents after 20 weeks gestation and is often asymptomatic at diagnosis. It can occur in the new first time mother as well as in a “veteran” mama. It presents in singleton pregnancies as well as in multiple gestations. There is no particular presentation or no particular type of mama who will develop pre-eclampsia. What is known is that women with pre-existing conditions such as high blood pressure, cardiovascular disease, diabetes, kidney disease, or clotting/blood disorders are at increased risk of developing pre-eclampsia. Pre-eclampsia is also more common in women with multiple gestations (Twins or more) and older mamas. The wild card is obesity. Some studies have shown that mamas who enter pregnancy overweight or obese increase their risks of developing pre-eclampsia. Other studies have not been conclusive. Currently obesity is not considered an absolute risk factor for pre-eclampsia, but given its negative effects on other aspects of mama’s health and hence baby’s health, obese mamas should be watched closely.

Pre-Eclampsia is classified as mild or severe and treatment is guided depending on the severity. Mild pre-eclampsia is defined as hypertension (BP >140/90 mmHg) on two occasions at least 6 hours apart, but without evidence of end-organ damage (kidney disease inparticular). Severe pre-eclampsia may include an array of signs and symptoms and significant laboratory findings. At least one of the following signs or symptoms must be present with the indicators of pre-eclampsia for the condition to be regarded as severe. Severe Pre-Eclampsia is a medical emergency and must be treated immediately, typically by immediate delivery of the infant so as to save the life of both mama and infant.

Symptoms of Severe Pre-Eclampsia

Neurological: blurred vision, severe headache, altered mental status, stroke, seizures

Liver Damage: Right Upper Quadrant abdominal pain, elevated liver enzymes indicating liver damage (Precursors to HELLP Syndrome, Hemolysis, Elevated liver enzyme levels, low platelet count)

Kidney: Protein in the urine, decreased urine output, dark urine

Pulmonary Edema: Fluid in the lungs

Fetal: Intrauterine Growth Retardation

Blood Disorders: Increase in blood clotting, Low platelet count

Treatment of Pre-eclampsia

As previously stated, severe pre-eclampsia and pre-eclampsia that has progressed to organ damage or HELLP Syndrome is a medical emergency and must be treated aggressively in the hospital setting. Mild pre-eclampsia can be treated with bed rest and medication with close watch for development of symptoms indicating progression to a more severe form.

Medications

Magnesium Sulfate-Magnesium sulfate is considered first-line treatment for the prevention of primary and recurrent eclamptic seizures. It is also utilized for prophylactic treatment in all patients with severe preeclampsia.

Anti-Hypertensive (high Blood Pressure)Medications – Medications known to decrease blood pressure but found to be safe in pregnancy are Hydralazine, Labetalol, Nifedipine, Nicardipine and Sodium Nitroprusside.

Aspirin Therapy – Low dose aspirin therapy is controversial in the treatment of pre-eclampsia. While an individual study was unable to prove benefit for using low dose aspirin therapy as a preventive for pre-eclampsia, a meta-analysis of several studies found that using low dose aspirin starting before 16 weeks of gestation and continuing throughout pregnancy. Currently, low dose aspirin therapy is not recommended as a preventive treatment for pre-eclampsia. Physicians and researchers are still trying to determine which women are at greatest risk for developing pre-eclampsia and which women will benefit from low dose aspirin therapy.

References:

Pre-Eclampsia Revisited. Tammy D. Hart, BS, PharmD, Martha B. Harris, BS, PharmD. November 20, 2012.

US Pharmacist. 2012;37(9):48-53. © 2012  Jobson Publishing

Aspirin in the prevention of pre-eclampsia in high risk women: a randomised placebo controlled PREDO trial and a meta analysis of randomised trials. Villa, P., Kajantie, E., Räikkönen, K., Pesonen, A.-K., Hämäläinen, E., Vainio, M., Taipale, P., Laivuori, H. and on behalf of the PREDO Study group (2012).  BJOG: An International Journal of Obstetrics & Gynaecology. doi: 10.1111/j.1471-0528.2012.03493.x

Leave a Reply

Your email address will not be published. Required fields are marked *