What is preeclampsia (toxemia)?

Preeclampsia is a life-threatening disease for both the mother and the baby. It can occur in the second half of pregnancy. An increase in blood pressure of a pregnant woman (higher than 140/90 mm Hg) and unexplained proteinuria (leakage of protein in the urine) are among common signs of this disease. Previously, edema of the mother’s body was also considered as a symptom of preeclampsia, but nowadays, the presence of edema is excluded from the criteria for diagnosing preeclampsia to avoid any confusion.

What causes preeclampsia?

Even though preeclampsia is known for more than 100 years, the exact causes of its occurrence are still not clear. Available medical information confirms that abnormalities in the placenta’s position on the uterine wall (as, for example, in the case of trophoblastic disease) are among the causes of preeclampsia. It is also known that due to anomalies in the location of the placenta on the uterine wall, many substances from the placenta area enter the mother’s systemic bloodstream. That causes damage to the cells that form the innermost layer of the vessels of the great circle of blood circulation (damage to the vascular endothelium). Thus, this deviation, affecting all the vessels of the mother’s body, turns preeclampsia into a systemic disease that threatens all the organs of the mother (brain, lungs, heart, liver).

 

Does preeclampsia pose a risk to the mother?

Leakage of vascular fluid due to damage to the maternal vessels affects all maternal systems. Leakage of brain fluid causes swelling, so the mother has headaches, visual disturbances (blurred vision, the appearance of flickering white dots or black spots in the field of vision), as well as vomiting due to increased intracranial pressure. In the later stages, as a result of brain function disorders, loss of consciousness and convulsions (eclampsia) may occur. In the case of eclampsia (loss of consciousness, convulsions), the mother’s condition can seriously deteriorate due to the ingestion of oral particles into the lungs. In cases of preeclampsia, edema of the lungs also occurs, which leads to their malfunctioning. Since the mother cannot fully inhale oxygen and exhale carbon dioxide, she begins to suffer from oxygen starvation, her complexion darkens, and her metabolic state deteriorates markedly.

Similarly, the leakage of vascular fluid in the liver causes edema. Edematous fluid accumulating under the liver capsule causes pain in the right upper abdomen and causes liver dysfunction. In more severe cases, ruptures of the liver capsule may occur. Again, due to liver damage and coagulation problems, the development of a dangerous disease called HELLP syndrome may occur (hemolysis: the destruction of red blood cells, an increase in liver enzymes, and a decrease in the number of platelets that allow blood to clot). HELLP-syndrome is a life-threatening disease for the mother. In preeclampsia, all the systems of the mother’s body are affected. Since preeclampsia is not the main topic of this article, we will not go into the details of this disease.

 

Does preeclampsia pose a risk to the baby?

Since preeclampsia is accompanied by placental abnormalities in the location on the uterine wall, this condition leads to an insufficient supply of nutrients to the fetus. This situation can cause growth retardation, decreased amniotic fluid (low water content), lack of oxygen (hypoxia), and even more serious fetal problems compared to their peers. For this reason, a good diagnosis and treatment are vital for both the mother and the baby.

 

How is preeclampsia diagnosed?

The diagnosis of preeclampsia is made in cases when pregnant women with previously normal blood pressure are found to have an increase (higher than 140/90 mm Hg). Also, the diagnosis of preeclampsia is made when the mother shows signs of damage to the vascular endothelium, such as protein leakage in the urine, the presence of the above-mentioned conditions associated with brain edema, as well as damage to the lungs, liver, and circulatory system.

 

How is preeclampsia treatment done?

Preeclampsia is treated mainly through childbirth. It is expected that the mother’s condition improves after the termination of pregnancy and removal of the placenta from the uterus. Although childbirth (termination of pregnancy) is the best option for the mother, it is not always so for the baby. Childbirth, which takes place even before the fetus completes its growth and maturation, can cause serious disorders, and even carry the risk of fetal death due to prematurity. Depending on the causes of preeclampsia, it is divided into categories. Cases of severe preeclampsia require termination of pregnancy, while treatment for preeclampsia, which does not carry serious threats to the body, is aimed at buying time and allowing the fetus to grow and mature as much as possible. If during routine examinations, it turns out that preeclampsia of a milder form begins to acquire a severe character, so as not to put the mother’s life at risk, specialists decide to terminate the pregnancy. It should also be remembered that the treatment of each patient may develop in different ways.

 

How should the delivery of patients with preeclampsia be taken? Which method can be considered the best?

After the decision to terminate the pregnancy of patients with preeclampsia is made, the delivery is usually carried out quickly. In terms of maternal recovery, it has not yet been proven that cesarean delivery is superior to natural delivery for patients with preeclampsia. Therefore, except for cases where a cesarean section is mandatory, natural birth is considered a priority delivery option. In other words, if there is no need for a cesarean section, the preferred method is vaginal delivery. Cesarean section is considered only in case of medical necessity (placenta previa, fetal distress (poor fetal condition), failure to perform natural childbirth, etc.). Again, an individual approach to each patient is important when making this decision.

 

Is it possible to identify patients who are likely to develop preeclampsia in advance?

Since the only way to treat severe preeclampsia is to terminate a pregnancy, which is not always the best option for the fetus, numerous studies have been conducted to predict patients who tend to develop preeclampsia. For example, to achieve this goal, resistance measurements in the vessels leading to the uterus were carefully studied, but, unfortunately, this screening method was not found to be effective. The study of certain biochemical substances in samples taken from the mother’s blood, together with the measurement of resistance in the vessels leading to the uterus, and the study of some other parameters, was also investigated to improve prognosis. Unfortunately, an acceptable and cost-effective method of screening for preeclampsia, which could be used everywhere, has not yet been found.

 

Is it possible to prevent the development of preeclampsia?

Studies conducted with expectant mothers to prevent preeclampsia have shown that the risk of developing preeclampsia may be reduced in some groups. Thus, with the help of medical intervention, in such groups, it is possible to reduce the risk of developing preeclampsia. Prevention in cases such as preeclampsia experienced during a previous pregnancy, the presence of high blood pressure (hypertension) before conception, diabetes and kidney disease before pregnancy, as well as connective tissue diseases (for example, as in systemic lupus erythematosus) helps prevent the development of preeclampsia. It is also worth noting that it is important to start preventive treatment even before the completion of placental development to increase the chances of a successful outcome of the procedures.

Our published scientific articles on preeclampsia:

International scientific journals

Correlation of maternal serum high-sensitive C-reactive protein levels with biochemical and clinical parameters in preeclampsia. Kumru S, Godekmerdan A, Kutlu S, Ozcan Z.Eur J Obstet Gynecol Reprod Biol. 2006 Feb 1;124(2):164-7. doi: 10.1016/j.ejogrb.2005.05.007. Epub 2005

Proteinuria in preeclampsia: is it important? Özkara A, Kaya AE, Başbuğ A, Ökten SB, Doğan O, Çağlar M, Kumru S.Ginekol Pol. 2018;89(5):256-261. doi:  10.5603/GP.a2018.0044.

Mean platelet volume, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in severe preeclampsia. Yavuzcan A, Cağlar M, Ustün Y, Dilbaz S, Ozdemir I, Yildiz E, Ozbilgeç S, Kumru S.Ginekol Pol. 2014 Mar;85(3):197-203.

Comparison of serum copper, zinc, calcium, and magnesium levels in preeclamptic and healthy pregnant women. Kumru S, Aydin S, Simsek M, Sahin K, Yaman M, Ay G.Biol Trace Elem Res. 2003 Aug;94(2):105-12. doi: 10.1385/BTER:94:2:105.

Changes of serum paraoxonase (an HDL-cholesterol-associated lipophilic antioxidant) and arylesterase activities in severe preeclamptic women. Kumru S, Aydin S, Gursu MF, Ozcan Z.Eur J Obstet Gynecol Reprod Biol. 2004 Jun 15;114(2):177-81. doi: 10.1016/j.ejogrb.2003.10.023.

Serum leptin and ghrelin concentrations of maternal serum, arterial and venous cord blood in healthy and preeclamptic pregnant women. Aydin S, Guzel SP, Kumru S, Aydin S, Akin O, Kavak E, Sahin I, Bozkurt M, Halifeoglu I.J Physiol Biochem. 2008 Mar;64(1):51-9. doi: 10.1007/BF03168234.

National Peer-Reviewed Journals

Kumru S, Gurates B, Sapmaz E, Özcan Z, Aydin S, “Study of plasma homocysteine levels in patients with mild and severe preeclampsia”, Journal of Perinatology, 1, 25-28 (2004).

Kumru S, Şimşek M, Gürateş B, Sapmaz E, Özcan Z Nalbant M, Aygün D, “Comparison of maternal and fetal outcomes in cases of HELLP syndrome and severe preeclampsia”, Journal of Perinatology, 13, 9-14 (2005).

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