Pre-eclampsia or as it used to be called: pregnancy poisoning in question and answer

  31. January 2023

“What is preeclampsia and should I be afraid of it as a pregnant woman?”
For starters, fear is rarely a good companion, but having respect for the disease and being informed about it is quite a good idea. Preeclampsia is a disease that can occur in about 2-8% of pregnant women worldwide and 2% in Europe. In Switzerland, the percentage is less than 2%. That is, it affects only about 2 out of every 100 pregnant women. The name preeclampsia means “before eclampsia”, whereas eclampsia is an epileptic seizure. The name refers to the most feared complication of the disease. However, this term describes the disease only incompletely and requires further explanations. Fortunately, an eclamptic attack occurs in only about 0.5 to 3% of all women with pre-eclampsia and in about 0.1% of all pregnancies. So it is a feared but rare complication of preeclampsia. Unfortunately, there is still no better term for the disease than “preeclampsia”, which is why it is also referred to as such in the following.

Why is this disease not called pregnancy poisoning?
The term “pregnancy poisoning” is an outdated term and suggests that one is poisoned by one's own pregnancy. But this is not correct when looking at the definition of poisoning:

"Poisoning refers to the absorption of harmful substances into the body and the resulting impairment of bodily functions." Pregnancy is not a substance that you have taken. It arises in you. Thus, the term is too inaccurate.

How does preeclampsia occur?
The exact origin of the disease is not exactly known. But the current theory is that the placenta does not implant itself in the tissue of the uterus as it should. As a result, the vessels of the placenta do not become as large as they should be and a constant overpressure arises at the implantation site. This causes substances to enter the bloodstream, which can have undesirable effects on various organs. The organs that can be affected are the liver, kidneys, brain, and placenta itself, and thus also the growth and ensuring the care of the child.
A fitting name for preeclampsia would therefore be, for example, "multisystem placental pregnancy disease".

What are the symptoms of preeclampsia?
The symptoms of preeclampsia are manifold and not all symptoms need to occur to make the diagnosis of preeclampsia. Perhaps you have noticed in pregnancy control that we often ask about these symptoms:

  • Headache or eye flickering/flickering (signs of brain involvement)
  • Pain in the upper right abdomen (where the liver is located)
  • Nausea
  • Water retention with rapid weight gain (the substances attack the vessels so that the water flows from the vessels into the tissue and can lead to thick hands and feet)
  • No more regular urination possible (a sign of kidney involvement)
  • Worsening of the general state of health (the feeling of being sick, but without a fever). These are the symptoms that you might notice yourself. In each check, we also look at their blood pressure. If this is too high, you have to continue looking and exclude a preeclampsia. Urine is also assessed at each check. If it has too many proteins in it, this can also be an indication of preeclampsia. Furthermore, if there is a suspicion, a blood sample is taken to clarify further parameters.

I have a unique headache during pregnancy and have had water retention for 3 weeks. Have I been diagnosed with preeclampsia? Just because you may have one of the possible symptoms doesn't mean you have preeclampsia.
However, if you notice any of the symptoms in yourself, then we would like to rule out preeclampsia and will take further diagnostic steps. And sometimes the diagnosis is not completely clear from the beginning and can only be confirmed after several visits.

I feel completely comfortable and healthy, but my doctor tells me that I have preeclampsia due to my findings. How is this possible if I am well?
This situation may well occur. You have no suspicion of harm and come to the check in a good mood and in a stable state and your doctor tells you that you have preeclampsia and appropriate treatment is indicated. It is important to understand that preeclampsia presents differently. One patient may be in a deteriorated state of health – with increased blood pressure and clearly poor body sensation – but the blood findings do not yet clearly indicate preeclampsia. Another patient may appear symptom-free in practice, but the blood pressure and blood and urine results show that she already has preeclampsia, but fortunately not yet with pronounced symptoms. In both cases, a treatment is indicated, which is individually determined. It's nice to feel good overall, but you should still take the advice of your healthcare professional to heart. Because the insidious thing about it is that your good health can change quickly.

Are there any risk factors for preeclampsia?
There are various risk factors that can make the occurrence of preeclampsia somewhat more likely. These include:

  • autoimmune diseases such as anti-phospholipid syndrome or lupus erythematosus- if you have already had preeclampsia-overweight with a body mass index of more than 30
  • in case of pre-existing diabetes mellitus
  • in case of family history (your mother or sister also already had preeclampsia)
  • in case of pre-existing kidney disease or diabetes mellitus
  • You suffer from high blood pressure even before pregnancy
  • You are over 40 years old
  • it's your first pregnancy
  • You have a dark skin color

Pregnancy risk factors:

  • multiple pregnancy
  • IVF/egg donation
  • gestational diabetes

Not all of these risk factors are equally difficult to assess. In conversation with a specialist, these risk factors can be classified.

My sister had preeclampsia and I am over 40 years old. Can I do nothing now and have to live with the increased risk?
In fact, there is a good prophylaxis that has been studied in a large-scale study. Together with your doctor, the first tests will determine whether you should perform this prophylaxis or whether it is not necessary.
At very high risk, such as if you have had preeclampsia yourself in the previous pregnancy, you will definitely receive such prophylaxis from the 12th week of pregnancy to minimize the risk.

Are there different types of preeclampsia?
There are two types of preeclampsia: early onset preeclampsia, which occurs before 34+0 weeks of pregnancy, and late-onset preeclampsia, which occurs after 34+0 weeks of pregnancy.
However, one can only speak of a preeclampsia from the 20+0 week of pregnancy. It usually does not occur before.
If preeclampsia occurs earlier, it is usually also somewhat more severe than preeclampsia which occurs later.

What is the treatment for preeclampsia?
It is important to know that there is only one causative treatment of preeclampsia, and that is childbirth. Because then the placenta is no longer in your body and the substances that probably cause all the symptoms are slowly broken down.
It depends on what week of pregnancy you are in.
If preeclampsia occurs after 37+0 weeks of pregnancy, it usually makes no sense to wait long. One should strive for childbirth. The child will not be born too early. However, this does not mean that you have to perform a cesarean section in any case. It all depends on your individual state of health. Sometimes experts also suggest an introduction. However, if the preeclampsia occurs before the 34+0 week of pregnancy, the child is still a little early. Therefore, you may be suggested to mature your child's lungs with medication. It is not always possible to wait until the child reaches maturity (i.e. the 37+0 week of pregnancy), namely when severe preeclampsia can be assumed. Sometimes your attending physicians will also give you magnesium through the vein. This does not serve to cure preeclampsia but is intended to prevent the above-mentioned eclamptic seizure. This prophylaxis is not always necessary. But if it is started, it will continue for one to two days even after birth. The treatment is always individual and tailored to your situation.

Am I healed when my child is in the world and the placenta is removed from my body?
In fact, childbirth is the only causal and healing therapy. However, even the first days after delivery, namely until seven days after, there is still the risk of suffering another complication of the disease. Therefore, blood pressure, urine, and blood tests will continue to be carried out. Some women need to be monitored a little longer and others can leave the hospital with their newborn relatively early, this is also individual. The risk that they will develop high blood pressure after a pronounced preeclampsia in your life is higher than in women who never had one. Therefore, in such a case, it is always recommended to have a family doctor's examination after six months and an annual examination of the blood pressure.

So the fear of preeclampsia seems justified given the severe effect?
The effects of preeclampsia are very drastic. However, it rarely occurs with us. The risk is further reduced with today's measures - the detection of risk factors and drug prophylaxis. In conversation with your doctor, these fears can be discussed in peace and your individual risk and further procedure can be planned in detail.

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