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Pregnancy and Childbirth: The answers

Potential complications of pre­-eclampsia

Apart from affecting the growing fetus, the disease affects various organs in the mother's body.

Ø There may be growth restriction in which case the baby will be very small with all the attendant potential problems.

Ø There is a high rate of prematurity which is associated with higher rates of morbidity and even mortality for the newborn.

Ø Premature separation of the afterbirth (placental abruption) may occur. The rate of fetal loss, as a consequence of this, is very high.

Ø The mother may suffer vital organ failure, such as liver or kidneys.

Ø Increased bleeding complications as a result of the inability of blood to clot. This is one of the less common but poten­tially very serious complications of severe pre-eclampsia.

Ø Stroke may result from severe pre-eclampsia.

Ø Eclampsia.

Understanding eclampsia

Pre-eclampsia gets its name from the fact that, it is the con­dition which precedes eclampsia. Historically, eclampsia was an issue because, with less than perfect antenatal care, this was sadly a common culmination of this syndrome. Nowa­days, it is not uncommon for a doctor to go through training and practice to retirement without seeing a case of eclampsia.

 

Basically, eclampsia is generalized convulsions or seizures with loss of consciousness, indistinguishable from an epileptic seizure. It is the ultimate complication of pre­-eclampsia. All measures instituted in pre-eclampsia are geared towards preventing this from happening.

 

Delivery to prevent eclampsia

It is important to be aware that delivery will not necessarily prevent eclampsia from happening. What is certain is that delivery is the beginning of the end of pre-eclampsia.

 

However, there is a critical period of about 48 to 72 hours following delivery in severe pre-eclampsia, where eclampsia might still happen. That is why intensive monitoring of the condition continues unabated in this immediate post-delivery period.

 

Eclamptic fits have been reported to occur up to seven days after delivery, but this is so rare that, for practical purposes, it can be safely discounted.

 

Occasionally, antihypertensive medication may need to be continued for several weeks after delivery to control the blood pressure. The risk of eclampsia, however, recedes rapidly after delivery and virtually disappears after the first four days. Other potential complications of raised blood pressure, such as stroke, may remain for some time. This is why it is essential to ensure well-controlled blood pressure.

 

Recurrence of pre-eclampsia in a subsequent pregnancy

The odds are that pre-eclampsia will not recur in the next pregnancy but it might. If this was the mother's first pregnancy, she has a roughly one in four to five(20 - 25%) chance of having the condition in her subsequent pregnancy. If she was affected in her second or later pregnancy, the risk is higher, up to one in two, i.e. 50%.

 

In a small group of patients, pre-eclampsia recurs in every pregnancy. These women are considered to have an underlying latent essential hypertension.

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