eclampsia

Pregnancy poisoning: description

The term pregnancy poisoning is actually outdated, but is still often used in colloquial language. He refers to an earlier theory that certain substances released by pregnancy in the body trigger poisoning. According to the current state of science this is not true. Rather, pregnancy poisoning is an adaptation disorder of the body to changes during pregnancy.

Diseases caused by pregnancy are called gestosis. A distinction is made between early gestures such as the morning vomiting during the second to fourth month of pregnancy and late gestosis, which includes the pregnancy poisoning. They occur after the 20th week of pregnancy. The late gestures are also referred to as hypertensive pregnancy diseases, because all too high blood pressure (hypertension) occurs. These include:

• Pregnancy hypertension (gestational hypertension)
• Preeclampsia (EPH-gestosis)
• eclampsia
• HELLP syndrome
• Graft preeclampsia

Pregnancy poisoning: occurrence

According to the guideline for high blood pressure diseases during pregnancy, six to eight percent of all pregnant women suffer from it. They are among the most common reasons why mothers die during pregnancy.

Pregnancy hypertension causes pre-eclampsia in almost half of those affected, with ten percent of them suffering from severe pre-eclampsia. This can lead to HELLP syndrome. In Europe, preeclampsia occurs annually in about two percent of all pregnant women. Every year, 70,000 women die of preeclampsia worldwide.

Women who have had high blood pressure before the onset of pregnancy and who suffer from it for more than 12 weeks after delivery have chronic hypertension. During pregnancy, this can turn into one of four women a Pfestkllampsie.

Pregnancy poisoning: symptoms

The signs of pregnancy poisoning can be found in Pregnancy Poisoning: Symptoms.

Pregnancy Poisoning: Causes and Risk Factors

The exact genesis mechanism of pregnancy poisoning has not yet been conclusively explored. Currently, doctors assume that it is an adjustment disorder of the body to the changes in pregnancy. Various factors play a role here. Among other things, one starts from a disturbance in the mother cake (placenta). This can lead to changes in the blood vessels of the expectant mother and activate her immune system. As a result, fluid escapes from the vessels, it forms water retention (edema) and the blood coagulation is activated.

Pregnancy poisoning: Who is affected?

Basically, every woman can get a Gestosis. However, there are several risk factors that favor the occurrence of pregnancy poisoning. These include:

• Occurrence of gestosis in a previous pregnancy
• Pregnancy with multiple births
• Age of pregnant women under 18 or over 40 years
• Autoimmune diseases
• Disorders of blood clotting
• first pregnancy
• obesity
• Diabetes mellitus
• Occurrence of gestoses in close relatives
• Diseases of the kidneys

Pregnancy poisoning: examinations and diagnosis

To detect pregnancy poisoning, visit your gynecologist. First, he asks you in detail about your medical history (anamnesis). He will ask you the following questions:

• Did you suffer from high blood pressure before you became pregnant?
• Is there a case of pregnancy poisoning in your family?
• Did you have any gestosis in a previous pregnancy?
• Do you have upper abdominal pain or blurred vision?

There is no specific test for the diagnosis of gestosis. Women are therefore undergoing various investigations:

First, your blood pressure is measured. He is often elevated in pregnancy poisoning. In rare cases it can have normal values.

In addition, your weight will be checked. Rapid increases in weight may indicate water retention and EPH-gestosis.

Furthermore, your urine will be tested for proteins. In the urine of healthy are usually no proteins.

In addition, blood is taken from you and examined in the laboratory. If the liver enzymes (transaminases) are elevated, this can be a sign of damage to the liver during pregnancy poisoning. The amount of platelets is also important: Decreased levels may indicate HELLP syndrome.

To assess the situation of the unborn child, a cardiotocography (CTG) should be performed. The CTG monitors the heartbeat of the child and labor. In addition, an ultrasound (sonography) can provide information about the baby’s blood supply and about its growth.

Sonography can also be used to detect changes in the mother’s liver. If there is no clear finding, a magnetic resonance imaging (MRI) can be performed.

Pregnancy poisoning: treatment

The treatment depends on the type of pregnancy poisoning and which symptoms are present. Water retention (edema), for example, can be treated by simple measures such as:

• Elevating the legs
• Wearing tight bandages or stockings
• 37 ° C warm baths

If you have only a slight pregnancy hypertension without other symptoms, the therapy can be done on an outpatient basis. It is important to avoid or reduce stress. Your gynecologist may issue you a certificate of incapacity or a work ban. In addition, you should have weekly check-ups with your gynecologist.

From a blood pressure of 150/100 mmHg pregnant women should be hospitalized in hospital.

Pregnancy poisoning: Therapy in the hospital

In the clinic, you can be constantly monitored and adjusted for certain antihypertensive drugs. This is important because lowering blood pressure can prevent life-threatening complications such as brain bleeding. As a blood pressure reducer, various drugs come into question. Most commonly, α-methyldopa, nifedipine or metoprolol is used to lower blood pressure in the long term. In the acute situation nifedipine, urapidil or dihydralazine is usually administered. The antihypertensive drugs should be slowly reduced in their dose in the three months after birth and finally stopped altogether.

Magnesium is given to prevent or treat the development of eclampsia.

Apart from that, it is important to monitor the baby’s health. That works best with the CTG.

The only way to causally treat a pre-eclampsia is to deliver the child. In patients who have already completed the 37th week of pregnancy, therefore, the birth is usually initiated. The baby is then mature enough for life outside the womb. Delivery is considered in women between the 35th and 37th week of pregnancy who have severe pre-eclampsia. Between the 25th and 34th week of pregnancy a drug treatment is preferred and an early childbirth is delayed as long as possible. Before the completed 24th week of pregnancy is individually decided whether the pregnancy is terminated. The focus here is on averting the danger to the mother.

If premature childbirth is required in the case of pregnancy poisoning, although the baby’s maturation is not yet complete, this can be accelerated first by medication. For this, the mother is once injected with the glucocorticoid betamethasone between the 25th and 34th week of gestation, preferably at least 48 hours before the birth.

In a HELLP syndrome, delivery is often initiated immediately because otherwise the situation can be life-threatening for both the mother and the child.

Pregnancy poisoning: prevention

If women have had a pre-eclampsia or similar disease in a previous pregnancy, they will be treated with acetylsalicylic acid (ASA) at the latest from the 16th week of pregnancy until the 34th week of pregnancy. This reduces the risk of reoccurrence of pregnancy poisoning until the 37th week of pregnancy. A general intake of ASA during pregnancy is not recommended.

Regardless of possible risk factors, all pregnant women from the 20th week of gestation will be tested for proteins in their urine. In addition, the blood pressure should be checked at each check-up. If it is too high but there are no other symptoms, for a more detailed check, a long-term blood pressure reading can be taken for 24 hours. In addition, pregnant women can regularly check their blood pressure in the morning and in the evening in order to detect a possible increase at an early stage.

Pregnancy poisoning: disease course and prognosis

Pregnancy poisoning can take many courses. Therefore, after the diagnosis, the constant monitoring of mother and child is crucial. The different types of hypertensive pregnancy disorders can partially overlap. For example, pre-eclampsia may first develop from a gestational hypertension, and an eclampsia or a HELLP syndrome may develop thereafter. Eclampsia can develop suddenly without any symptoms and can be life-threatening for the pregnant woman within a few hours.

In general, the various diseases are usually more serious for the expectant mother than for the child – they threaten their cerebral hemorrhage, kidney failure and liver rupture. In the unborn child, maternal hypertension may delay growth. A HELLP syndrome can also be life-threatening due to premature placental ablation for the unborn child.

Women who already have one eclampsia had an increased risk of recurrence at their next pregnancy. Thus, a pre-eclampsia and a HELLP syndrome are repeated in about 15 percent of those affected.