Synonym: late gestosis,
Pregnancy poisoning; Preeclampsia is a form of high blood pressure (hypertension) that is caused by pregnancy. By definition, high blood pressure must not have existed before the 20th week of pregnancy. In addition to high blood pressure, which assumes values above 140/90 mmHg, there is a so-called proteinuria.
This means that there is a loss of protein in the urine via the kidneys. With intact kidney function, these proteins would be filtered out of the urine and remain in the body.
By definition, preeclampsia loses over 300 mg of protein per 24 hours in the urine. If proteinuria is not present, preeclampsia may be present if the kidney or liver is impaired, the blood count is abnormal, or neurological abnormalities. Furthermore, a growth retardation of the fetus in the presence of pregnancy high blood pressure is also regarded as preeclampsia. The old term “EPH gestosis” is no longer used for preeclampsia.
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Causes of Preeclampsia
The causes for the occurrence of preeclampsia are still current Subject of research.
Known risk factors exist, but the exact mechanism of the disease is not fully understood. It will be different Disorders of prostaglandin metabolism as well as a disturbed adaptation of important vessels of the placenta discussed.
According to a study, one should also Vitamin D Deficiency in Early Pregnancy increase the risk of preeclampsia.
Keep playing Substances regulating blood pressure, which are known as endothelial factors, play a central role in the development of preeclampsia. The higher the sFlt-1 / PIGF quotient the higher the probability of developing preeclampsia.
This quotient measures important factors in the Blood supply to the child and the placenta. He rises at one Undersupply of the placenta.
A certain one genetic risk is also not to be dismissed out of hand. Immunological and hormonal factors are also suspected.
However, many women ask themselves whether there are specific risk factors for the occurrence of preeclampsia. There are indeed general risk factors as well as pregnancy-related risk factors. The following overview summarizes the risk factors for preeclampsia. The more risk factors a person has, the higher the risk of developing preeclampsia.
1. Pregnancy-related risk factors:
- 1.1. Preeclampsia in a previous pregnancy or any other pregnancy disorder associated with high blood pressure
- 1.2. Primiparous (60-70% of all preeclampsia are found in primiparous women)
- 1.3. Multiple pregnancies
- 1.4. Gestational diabetes
- 1.5. Fetal chromosome aberrations
2. General risk factors:
- 2.1. Thrombophilia: antiphospholipid syndrome
- 2.2. Overweight: BMI> 35
- 2.3. Diabetes mellitus
- 2.4. Autoimmune diseases
- 2.5. Family stress
- 2.6. Existing kidney disease
- 2.7. Age> 40 years
Screening for Preeclampsia
There is currently no single and reliable screening test for the detection of preeclampsia. However, to assess the risk of preeclampsia in the first and second trimester of pregnancy, tests can be carried out and risk factors of the mother can be recorded.
1. Screening in the 1st trimester of pregnancy:
In the first trimester of pregnancy, the risk can be determined with a very high probability by collecting important maternal risk factors, such as ethnicity, age, BMI and many more, in combination with further examinations.
In addition, important biochemical values such as the PAPP-A and PIGF values are determined. The measurement of the mean arterial blood pressure and the Doppler examinations of an important artery (uterine artery) are also used to estimate the risk.
Only the collation of all these examinations and values allows a relatively precise estimate of the risk of preeclampsia.
2nd screening in the 2nd trimester of pregnancy:
In the second trimester of pregnancy, an important quotient can also be determined if there is an increased risk. This is called the sFlt-1 / PIGF quotient. In the case of abnormal abnormalities, it is carried out in the Doppler examination of the vessels in order to enable a more precise diagnosis. The values that are determined for this quotient indicate important factors in the blood flow to the placenta and fetus. A high quotient indicates an increased risk of developing preeclampsia.
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What are the signs of preeclampsia?
Basically there is no signs, but only Symptoms preeclampsia.
A increased blood pressure can cause headaches, nausea or a decreased well-being in the pregnant woman. However, increased blood pressure is usually more likely symptom-freeso that the pregnant woman does not necessarily have to notice anything.
One is possible rapid weight gain owing to Water retention. Weight gain occurs within a few hours to a day. Also a Decrease in urine output is suspect of preeclampsia.
Shortness of breath can also be an indication of developing preeclampsia. The shortness of breath comes through a Pulmonary edema conditions.
In addition, a Retardation of child growth a sign of preeclampsia. Upper abdominal pain speaks for one Liver dysfunction.
At Dizziness, blurred vision or even Seizures extreme caution is required. Care must be taken directly at the hospital, as this is already a Eclampsia can act. Eclampsia is a possible one Complication of preeclampsia dar and go with llife-threatening seizures of the mother.
What is the preeclampsia quotient?
The preeclampsia quotient measures the ratio of important biochemical markers that are closely related to the adaptation of the vessels of the placenta to pregnancy.
These markers are called sFlt-1 and PIGF. The marker sFlt-1 is a soluble receptor that is increasingly formed by the placenta in preeclampsia. It is an important factor in the formation of new vessels. At the same time, if there is an insufficient supply, which plays an important role in preeclampsia, the PIGF factor is increasingly produced by the mother.
The higher the sFlt-1 / PIGF quotient, the higher the probability of preeclampsia.
In the case of pathological changes in the Doppler examination of the arteries in the second trimester of pregnancy, the sFlt-1 / PIGF quotient is also determined. In this way, the likelihood of preeclampsia can be more accurately predicted.
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Accompanying symptoms of preeclampsia
In addition to high blood pressure and proteinuria, there are also important accompanying symptoms of preeclampsia. Basically all of the mother's organ systems can be affected, so that the accompanying symptoms are very diverse.
You may experience shortness of breath, reduced urine output and upper abdominal pain. Blood coagulation disorders, severe headaches, visual disturbances, dizziness and nausea are also possible accompanying symptoms.
A strong weight gain (> 1 kg) within a few hours suggests the presence of water retention (edema). Ultimately, a child's growth retardation on ultrasound is an indication of preeclampsia.
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- Edema in pregnancy, epigastric pain in pregnancy
- Placental insufficiency
Preeclampsia without high blood pressure
By definition, preeclampsia is a condition that occurs with one increased blood pressure and one Proteinuria goes hand in hand. Hence exists no preeclampsia without high blood pressure. Proteinuria does not necessarily have to be present if there are functional disorders in the liver or kidneys, abnormalities in the blood count or neurological disorders.
Symptoms of preeclampsia after childbirth
The symptoms of preeclampsia are usually related to that Time of pregnancy limited. They quickly subside after pregnancy. Of the High blood pressure does not persistbecause it arises from the circumstances of pregnancy.
Women with preeclampsia do not have high blood pressure either before or after giving birth. Within 4 to 6 weeks the woman's condition improves again. The kidney function gradually returns to normal so that the kidney values are back in the normal range.
Complications that can arise after a pre-eclamspie, such as the Eclampsia or that HELLP syndrome, can have lasting consequences for the mother. These include kidney failure or even cerebral hemorrhage. However, such complications do not occur with preeclampsia.
Therapy for preeclampsia
Preeclampsia must stationary be treated.
Women diagnosed with preeclampsia will be closely monitored. You must adhere to bed rest and maintain with systolic values over 160mmHg or diastolic values over 110mmHg antihypertensive drugs.
The drug of choice is the active ingredient alpha-methyldopa. The active ingredients provide alternatives Nifedipine, Urapidil and in the first and second trimesters Metoprolol represent.
The blood pressure lowering is allowed not outside the clinic take place as strict control is necessary. Check-ups for women are the most important measures to be taken in preeclampsia healing therapy does not exist. The goal of monitoring and therapy is to prevent complications.
If the baby is threatened with premature birth, be the mother Glucocorticoids administered to the Promote lung maturation of the child. In the extreme case, a Emergency caesarean section be performed. Will continue magnesium administered into the vein to a Prevent eclampsia. The serum levels of magnesium must be monitored closely.
If you have fluid build-up in the lungs (Pulmonary edema) can be careful diuretic drugs can be used. In addition, pregnant women receive on ward Heparinto prevent thrombosis. Of the Protein loss can through the gift of Human albumin be balanced into the vein.
It should a prompt delivery be sought. Depending on the risk to the mother, early delivery may be necessary even if the child is immature.
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Duration of preeclampsia
Preeclampsia is usually due to that Duration of pregnancy limited. However, it can take several weeks after the birth for all values and especially blood pressure to stabilize again. In some women, the condition normalizes within a few days, while others only reach normal blood pressure values after several months. Only in the rarest of cases does high blood pressure persist after pregnancy. Older women in particular are at increased risk of this. Preeclampsia can after the 20th week of pregnancy begin and until delivery consist.
What are the consequences of preeclampsia for the baby?
Preeclampsia should not be taken lightly. It requires clinical monitoring and treatment to prevent consequences for mother and child.
Preeclampsia can lead to growth retardation in the unborn child. Furthermore, the risk of premature birth is increased.
Premature births can have many complications and should therefore be prevented if possible. Damage to the lungs, intestines, eyes, cerebral haemorrhage and a slow heart rate (bradycardia) are possible effects of premature birth.
Long-term development delays and disabilities can be the result. However, monitoring and treating preeclampsia can avoid these risks. In the case of premature birth, intensive care measures can also prevent long-term consequences. Preeclampsia can also lead to premature detachment of the placenta. This detachment of the placenta has dramatic consequences for mother and child. This can cause the unborn child to die in the womb.
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What are the consequences of preeclampsia for the mother?
Preeclampsia can have serious consequences for the mother. However, with good monitoring and treatment, the risks of complications are low.
In principle, can Damage to the kidney, liver and nervous system arise. Important complications that must be mentioned in this context are Eclampsia and the HELLP syndrome.
Eclampsia is a serious condition that comes with Mother's seizures goes hand in hand. It increases with every eclipse seizure Mother's risk of dying by 3% on. Therefore, treatment in a clinic must be carried out immediately. Eclampsia does not necessarily have to be related to preeclampsia. However, it occurs in up to 10% of preeclampsia on.
The HELLP syndrome is a condition in which it occurs Liver damage, Cerebral haemorrhagegen and one acute kidney failure can come. It is life threatening and occurs in up to 10% of preeclampsia on. In the case of HELLP syndrome, a Caesareant done. After preeclampsia, the risk of preeclampsia in a new pregnancy is also increased.
What is the difference to the HELLP syndrome?
The HELLP syndrome and the Preeclampsie are different diseasesthat do not necessarily have to be related to one another.
The exact mechanism of the development of both diseases is still not understood and is the subject of research. The HELLP syndrome can already be in the 16th week of pregnancy occur and still arise days after birth, whereas the pre-eclampsia at the earliest after the 20th week of pregnancy can arise and also end when the pregnancy is terminated.
The HELLP syndrome continues in Spurts and is through one Dissolution of the red blood cells (Hemolysis), one Platelet decrease and increased liver values marked. A restriction of the kidneys and a proteinuria, as it is in the foreground in preeclampsia, are not present.
At a HELLP syndrome paradoxically many arise small thromboses and Bleeding.
Typical symptoms are Headache, right-sided abdominal pain, nausea, eye flicker and a Photosensitivity.
Unlike preeclampsia, this represents HELLP syndrome a reason for one immediate caesarean section at the end of pregnancy.