Simple checks and treatments can prevent one of the deadliest disorders in pregnant women

lifestyle May 24, 2019

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Effective prenatal screening in combination with simple preventive treatments could reduce maternal deaths resulting from pre-eclampsia from 50,000 annually to less than 9,000.

American singer-songwriter Beyonce Knowles not long ago hit the tabloid headlines after delivering a beautiful pair of twins, Sir and Rumi. Less well known are the difficulties she had with her pregnancy, which culminated in a pre-term emergency C-section after high-risk complications developed that threatened the lives of Beyonce and her babies.

The life-threatening condition that struck the superstar is known as pre-eclampsia (previously known as toxemia), which is caused by a sudden increase in blood pressure in pregnant women. Pre-eclampsia is surprisingly common - as many as 10% has  hypertensive disorder in pregnancy with 3% of them experience has preeclampsia. Pre-eclampsia cause 50,000 maternal death/year every year and it is the No. 3 cause of maternal death in Thailand yet very few people have even heard about it and its causes are not well understood.

Nonetheless, according to Boonsri Chanrachakul, M.D., PhD, Head of Maternal Fetal Medicine at Samitivej Sukhumvit Hospital, pre-eclampsia is one of the easiest prenatal conditions to predict and prevent, and most deaths caused by the condition are avoidable.

"Some 50,000 (worldwide) mothers die every year from pre-eclampsia, around 10-15 percent of all maternal deaths. Yet with optimization of ante-natal care, effective screening and simple preventive solutions, most of these deaths can be avoided easily ," he says.

Pre-eclampsia is characterized by hypertension and high levels of protein in the urine that begin to manifest after about the 20th week of pregnancy. Without proper care and management, the condition can lead to serious complications and can even prove fatal for both mother and baby.

For the mother, complications can include major organ damage, placental abruption, eclampsia (convulsions) and stroke, a heightened risk of cardiovascular disease in later life, and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) - the most serious condition that often results in maternal death. For the fetus, pre-eclampsia causes restricted growth and pre-term birth, which in combination can result in sub-optimal development in later life.

Mothers at the highest risk of pre-eclampsia are those that have experienced the condition in previous pregnancies, multifetal pregnancy (twins, triplets, etc.), and those with renal disease, autoimmune conditions, types I and II diabetes, or chronic hypertension.

Moderate risk factors include first pregnancy, age (over 35), obesity, a family history of pre-eclampsia, certain socio-demographic characteristics (notably African American women) or a number of other personal history factors, such as a large interval between pregnancies.

Combined screening for pre-eclampsia should be carried out around 11-13 weeks into the pregnancy. The screening involves an assessment of the risk factors, a uterine artery ultrasound test, maternal blood pressure check and a blood test to determine levels of placental growth factor or PlGF, a hormone that promotes vascularity in the placenta. Low levels of PlGF or restricted arterial blood flow are both indications for pre-eclampsia.

According to Dr. Boonsri, the simple screening procedures are successful in detecting the onset of pre-eclampsia 75-100 percent of the time, and are particularly useful in detecting more serious cases.

Prevention of the disorder is through the daily administration of low-dose aspirin before 16th till 36th weeks, an extremely simple and low-cost measure, that can reduce the incidence of pre-eclampsia by as much as 62-82 percent. Dr. Boonsri emphasizes, however, that preventive action must be before the 16th  week of the gestation period for at-risk mothers. Any later than that and the placenta will already be fully formed and preventive measures will no longer be effective.

Preventive screening for pre-eclampsia can be undertaken conveniently along with prenatal screening for congenital abnormalities and genetic disorders such as Down's syndrome at the Maternal Fetal Medicine Clinic of Samitivej Sukhumvit Hospital. The hospital's experienced team of OB/GYN specialists have expertise in high-risk pregnancy care and the administration of preventive measures, supported by the latest technologies and equipment, to minimize the risks of pre-eclampsia and other complications that may afflict expecting mothers.

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